Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy on relation to delayed enhancement on cardiovascular magnetic resonance

被引:457
作者
Adabag, A. Selcuk [1 ]
Maron, Barry J. [2 ]
Appelbaum, Evan [3 ,4 ,5 ]
Harrigan, Caltlin J. [4 ,5 ]
Buros, Jacqueline L. [4 ,5 ]
Gibson, C. Michael [3 ,4 ,5 ]
Lesser, John R. [2 ]
Hanna, Constance A. [2 ]
Udelson, James E. [6 ]
Manning, Warren J. [3 ,4 ,5 ]
Maron, Martin S. [6 ]
机构
[1] Vet Affairs Med Ctr, Sect Cardiol 111 C, Minneapolis, MN 55417 USA
[2] Minneapolis Heart Inst Fdn, Hypertroph Cardiomyopathy Ctr, Minneapolis, MN USA
[3] Beth Israel Deaconess Med Ctr, Dept Med, Div Cardiovasc, Boston, MA 02215 USA
[4] Harvard Univ, Sch Med, PERFUSE Core Lab, Boston, MA USA
[5] Harvard Univ, Sch Med, Data Coordinating Ctr, Boston, MA USA
[6] Tufts Univ New England Med Ctr, Div Cardiol, Hypertrop Cardiomyopathy Ctr, Boston, MA USA
关键词
D O I
10.1016/j.jacc.2007.11.071
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives Our aim was to determine whether myocardial fibrosis, detected by cardiovascular magnetic resonance (CMR), represents an arrhythmogenic substrate in hypertrophic cardiomyopathy (HCM). Background Myocardial fibrosis is identified frequently in HCM; however, the clinical significance of this finding is uncertain. Methods We studied prevalence and frequency of tachyarrhythmias on 24-h ambulatory Holter electrocardiogram (ECG) with regard to delayed enhancement (DE) on contrast-enhanced CMR in 177 HCM patients (age 41 +/- 16 yrs; 95% asymptomatic or mildly symptomatic). Results Premature ventricular contractions (PVCs), couplets, and nonsustained ventricular tachycardia (NSVT) were more common in patients with DE than those without DE (PVCs: 89% vs. 72%; couplets: 40% vs. 17%; NSVT: 28% vs. 4%; p < 0.0001 to 0.007). Patients with DE also had greater numbers of PVCs (202 +/- 655 vs. 116 +/- 435), couplets (1.9 +/- 5 vs. 1.2 +/- 10), and NSVT runs (0.4 +/- 0.8 vs. 0.06 +/- 0.4) than non-DE patients (all p < 0.0001); DE was an independent predictor of NSVT (relative risk 7.3, 95% confidence interval 2.6 to 20.4; p < 0.0001). However, extent (%) of DE was similar in patients with and without PVCs (8.2% vs. 9.1%; p = 0.93), couplets (8.5% vs. 8.4%; p = 0.99), or NSVT (8.3% vs. 8.5%; p = 0.35). Conclusions In this large HCM cohort with no or only mild symptoms, myocardial fibrosis detected by CMR was associated with greater likelihood and increased frequency of ventricular tachyarrhythmias (including NSVT) on ambulatory Holter ECG. Therefore, contrast-enhanced CMR identifies HCM patients with increased susceptibility to ventricular tachyarrhythmias.
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收藏
页码:1369 / 1374
页数:6
相关论文
共 41 条
[1]   Implications of arrhythmias and prevention of sudden death in hypertrophic cardiomyopathy [J].
Adabag, A. Selcuk ;
Maron, Barry J. .
ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, 2007, 12 (02) :171-180
[2]   Spectrum and prognostic significance of arrhythmias on ambulatory Holter electrocardiogram in hypertrophic cardiomyopathy [J].
Adabag, AS ;
Casey, SA ;
Kuskowski, MA ;
Zenovich, AG ;
Maron, BJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2005, 45 (05) :697-704
[3]   Accurate and objective infarct sizing by contrast-enhanced magnetic resonance imaging in a canine myocardial infarction model [J].
Amado, LC ;
Gerber, BL ;
Gupta, SN ;
Szarf, G ;
Schock, R ;
Nasir, K ;
Kraitchman, DL ;
Lima, JAC .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 44 (12) :2383-2389
[4]   Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy [J].
Assomull, Ravi G. ;
Prasad, Sanjay K. ;
Lyne, Jonathan ;
Smith, Gillian ;
Burman, Elizabeth D. ;
Khan, Mohammed ;
Sheppard, Mary N. ;
Poole-Wilson, Philip A. ;
Pennell, Dudley J. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 48 (10) :1977-1985
[5]   Hypertrophic cardiomyopathy and sudden death in the young: Pathologic evidence of myocardial ischemia [J].
Basso, C ;
Thiene, G ;
Corrado, D ;
Buja, G ;
Melacini, P ;
Nava, A .
HUMAN PATHOLOGY, 2000, 31 (08) :988-998
[6]   Delayed contrast-enhanced magnetic resonance imaging for the prediction of regional functional improvement after acute myocardial infarction [J].
Beek, AM ;
Kühl, HP ;
Bondarenko, O ;
Twisk, JWR ;
Hofman, MBM ;
van Dockum, WG ;
Visser, CA ;
van Rossum, AC .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 42 (05) :895-901
[7]   Infarct morphology identifies patients with substrate for sustained ventricular tachycardia [J].
Bello, D ;
Fieno, DS ;
Kim, RJ ;
Pereles, S ;
Passman, R ;
Song, G ;
Kadish, AH ;
Goldberger, JJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2005, 45 (07) :1104-1108
[8]   Standardizing the definition of hyperenhancement in the quantitative assessment of infarct size and myocardial viability using delayed contrast-enhanced CMR [J].
Bondarenko, O ;
Beek, AM ;
Hofman, MBM ;
Kühl, HP ;
Twisk, JWR ;
van Dockum, WG ;
Visser, CA ;
van Rossum, AC .
JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE, 2005, 7 (02) :481-485
[9]   Myocardial scarring in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy [J].
Choudhury, L ;
Mahrholdt, H ;
Wagner, A ;
Choi, KM ;
Elliott, MD ;
Klocke, FJ ;
Bonow, RO ;
Judd, RM ;
Kim, RJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 40 (12) :2156-2164
[10]   Late hyperenhancement in gadolinium-enhanced magnetic resonance imaging: comparison of hypertrophic cardiomyopathy patients with and without nonsustained ventricular tachycardia [J].
Dimitrow, Pawel Petkow ;
Klimeczek, Piotr ;
Vliegenthart, Rozemarijn ;
Pasowicz, Mieczyslaw ;
Oudkerk, Matthijs ;
Podolec, Piotr ;
Tracz, Wieslawa ;
Dubiel, Jacek S. .
INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING, 2008, 24 (01) :77-83