European journal of preventive cardiology · 2025
Arrhythmic risk stratification in patients with left ventricular ring-like scar.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Parisi Vanda, Graziosi Maddalena, Lopes Luis R, De Luca Antonio, Pasquale Ferdinando, Tini Giacomo, Targetti Mattia, Cueto Maria R, Moura Ana R, Ditaranto Raffaello, Torlasco Camilla, Taglieri Nevio, Nardi Elena, Lovato Luigi, Augusto João B, Galiè Nazzareno, Crotti Lia, Gasperetti Alessio, Biffi Mauro, Autore Camillo, Merlo Marco, Olivotto Iacopo, Sinagra Gianfranco, Elliott Perry M, Biagini Elena
Аннотация
AIMS: Left ventricular (LV) ring-like scar on cardiac magnetic resonance (CMR) has been linked to malignant arrhythmias in patients with non-ischaemic cardiomyopathy. This study aimed to perform a comprehensive evaluation of this phenotype and to identify risk factors for life-threatening arrhythmic events (LAEs), a composite of sudden cardiac death (SCD), aborted SCD, and sustained ventricular tachycardia.
METHODS AND RESULTS: One hundred and fifteen patients [median age 39 (interquartile range, IQR, 28-52), 42% females] were identified at 6 referral centres. Inclusion criteria were ring-like LV scar [≥3 contiguous segments with sub-epicardial/midwall late gadolinium enhancement (LGE) in the same slice] and one among: pathogenic/likely pathogenic genetic variant, family history for cardiomyopathy, or arrhythmogenic cardiomyopathy diagnosis. During the study follow-up, survival free from LAEs was 60% (3.8 events/100 patients/year); at a median follow-up of 4.6 years (IQR 1.7-8.4) it was 84%. On multivariable analysis, anterior Q waves [hazard ratio (HR): 1.030, 95% confidence intervals (CI): 1.014-1.046, P < 0.001], QRS width (HR: 4.642, 95% CI: 1.296-16.628, P = 0.018), and LV end-diastolic volume index (LVEDVi; HR: 1.011, 95% CI: 1.001-1.021, per mL/m2 increase, P = 0.040) were independently associated with LAEs; with good discrimination power (Harrell's C-index = 0.796). Three risk categories were identified: normal electrocardiogram (ECG), abnormal ECG and no LAEs predictive variables, abnormal ECG and ≥1 LAEs predictive variables, with a decreasing survival from 100 to 65% and 49%, respectively (Log-rank test = 0.015).
CONCLUSION: In this study, the LV ring-like scar phenotype was associated with a high rate of malignant arrhythmias in presence of anterior Q waves, QRS prolongation, and increased LVEDVi. A normal ECG identified a lower risk sub-group.
METHODS AND RESULTS: One hundred and fifteen patients [median age 39 (interquartile range, IQR, 28-52), 42% females] were identified at 6 referral centres. Inclusion criteria were ring-like LV scar [≥3 contiguous segments with sub-epicardial/midwall late gadolinium enhancement (LGE) in the same slice] and one among: pathogenic/likely pathogenic genetic variant, family history for cardiomyopathy, or arrhythmogenic cardiomyopathy diagnosis. During the study follow-up, survival free from LAEs was 60% (3.8 events/100 patients/year); at a median follow-up of 4.6 years (IQR 1.7-8.4) it was 84%. On multivariable analysis, anterior Q waves [hazard ratio (HR): 1.030, 95% confidence intervals (CI): 1.014-1.046, P < 0.001], QRS width (HR: 4.642, 95% CI: 1.296-16.628, P = 0.018), and LV end-diastolic volume index (LVEDVi; HR: 1.011, 95% CI: 1.001-1.021, per mL/m2 increase, P = 0.040) were independently associated with LAEs; with good discrimination power (Harrell's C-index = 0.796). Three risk categories were identified: normal electrocardiogram (ECG), abnormal ECG and no LAEs predictive variables, abnormal ECG and ≥1 LAEs predictive variables, with a decreasing survival from 100 to 65% and 49%, respectively (Log-rank test = 0.015).
CONCLUSION: In this study, the LV ring-like scar phenotype was associated with a high rate of malignant arrhythmias in presence of anterior Q waves, QRS prolongation, and increased LVEDVi. A normal ECG identified a lower risk sub-group.