Among 122 patients with ring-like LV scar, 20% had arrhythmic events; mixed mid-wall and apical LGE patterns were linked to higher primary endpoint risk.
Do specific patterns of 'ring-like' late gadolinium enhancement on CMR predict the risk of death, sustained VT, or ICD shocks in patients with non-ischemic cardiomyopathy?
In patients with a 'ring-like' LGE pattern on CMR, mixed-type patterns involving the mid and apical walls are associated with a significantly higher risk of death and severe ventricular arrhythmias.
Absolute Event Rate: 0% vs 0%
Abstract Background Left ventricular (LV) scar with a "ring-like" pattern detected by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) has been associated with an increased risk for ventricular arrhythmias and sudden cardiac death (SCD). However, the used definition varies between studies. We aimed to assess the differences across available definitions. Methods Retrospective single-center study of consecutive patients undergoing CMR and LGE study. A "ring-like" pattern was broadly identified by the presence of non-subendocardial (mid-wall and/or sub-epicardial) LGE involving at least three adjacent myocardial segments, as per the standardized AHA 17-segment model. Those with acute myocarditis and specific myocardial diseases (other than dilated cardiomyopathy) were excluded. The primary endpoint was a composite of death, sustained ventricular tachycardia (VT), or implantable cardioverter-defibrillator (ICD) shocks. Results Among 4,528 patients undergoing CMR, 210 (4.6%) exhibited a "ring-like" pattern, of whom 88 (42%) were excluded due to specific etiologies. Thus, 122 patients were assessed (mean age 60±18 years; 80% male; 61% NYHA I; mean left ventricular ejection fraction (LVEF) 42±14%; family history of cardiomyopathy or SCD in 5%). Mixed mid-wall and sub-epicardial patterns predominated (53%), followed by isolated mid-wall (34%). LGE was most prevalent in the basal segments (88%), followed by mid (48%) and apical walls (36%), involving 7±3 segments overall and 4±1 segments per ring. During a median follow-up of 12 (4-22) months, 25 (20%) patients had an event of the primary endpoint (13 VT, 7 deaths and 5 ICD shocks). These patients were older (67±10 vs. 58±19 years, p=0.032), more often with SCD in first degree family members (12% vs. 3%, p=0.044), with more cardiovascular symptoms (palpitations 40% vs. 18%, p=0.007; syncope 36% vs. 7%, p0.001), structural heart disease (LVEF 36±13% vs. 43±14%, p=0.028; LV end-diastolic volume 233±59 vs. 193±64 mL, p=0.006), and higher native T1 mapping values (1079±85 vs. 1033±52ms, p=0.008). Patients with an event of the primary endpoint had a higher number of overall segments with mid-wall or sub-epicardial LGE (9±4 vs. 7±3; p0.001), even though the number of segments involved in each ring per se was similar to other patients (4±1 vs. 4±1; p=0.089). Their rings more frequently exhibited a mixed pattern (68% vs. 48%, p=0.042), having more involvement of the mid (76% vs. 40%, p=0.001) and apical (36% vs. 8%, p0.001) walls, as well as more often presenting with LGE in the right ventricle (8% vs. 1%, p=0.046). Conclusion Our data suggests that different "ring-like" patterns may have varying degrees of association with the risk of arrhythmic events. Patients with mixed-type "ring-like" involving mid and apical walls were particularly more likely to have had an event of the primary outcome.
Carvalho et al. (Sat,) reported a other. Among 122 patients with ring-like LV scar, 20% had arrhythmic events; mixed mid-wall and apical LGE patterns were linked to higher primary endpoint risk.