共 41 条
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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页码:1369 / 1374
页数:6
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