Mean Scar Entropy by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Associated With Ventricular Arrhythmias Events in Hypertrophic Cardiomyopathy.

Yang Ye,Yaxun Sun,Chenyang Jiang,Hongjie Hu,Hong Ren,Zhongping Ji,Feidan Yu,Xiuhua Hu,Dongwu Lai,Ya Li,Cailing Pu,Chengqin Zhou,Bei Wang,Wenli Zhou,Chao Chen,Wenjuan Zhang,Yue Qian ,Qiangsheng Huang ,Yanfang Mao ,João Augusto ,Guosheng Fu

doi:10.3389/fcvm.2021.758635

Abstract

Background: Ventricular arrhythmias are associated with sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). Previous studies have found the late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) was independently associated with ventricular arrhythmia (VA) in HCM. The risk stratification of VA remains complex and LGE is present in the majority of HCM patients. This study was conducted to determine whether the scar heterogeneity from LGE-derived entropy is associated with the VAs in HCM patients.Materials and Methods: Sixty-eight HCM patients with scarring were retrospectively enrolled and divided into VA (31 patients) and non-VA (37 patients) groups. The left ventricular ejection fraction (LVEF) and percentage of the LGE (% LGE) were evaluated. The scar heterogeneity was quantified by the entropy within the scar and left ventricular (LV) myocardium.Results: Multivariate analyses showed that a higher scar [hazard ratio (HR) 2.682; 95% CI: 1.022–7.037; p = 0.039] was independently associated with VA, after the adjustment for the LVEF, %LGE, LV maximal wall thickness (MWT), and left atrium (LA) diameter.Conclusion: Scar entropy and %LGE are both independent risk indicators of VA. A high scar entropy may indicate an arrhythmogenic scar, an identification of which may have value for the clinical status assessment of VAs in HCM patients.

Highlights

Cardiac magnetic resonance imaging is a valuable tool for the risk stratification of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM)
A total of 68 HCM patients with scarring identified by both late gadolinium enhancement (LGE)-cardiac magnetic resonance imaging (CMR) and dynamic ECG (DCG) were enrolled in our study (Mean age: 68.7 ± 12.2 years; 69.1% male)
Our study demonstrated that the LGE-CMR-based calculations of entropy within the scar were associated with the occurrence of ventricular arrhythmias (VAs)

Summary

Introduction

Cardiac magnetic resonance imaging is a valuable tool for the risk stratification of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). The current study aims to determine whether the quantification of [1] scar heterogeneity, quantified by the entropy within the scar, may be considered a marker for inhomogeneous scar composition and to assess any association with VAs, and [2] the entropy of the entire LV quantify inhomogeneous fibrosis and assess any association with VAs. Ventricular arrhythmias are associated with sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). Previous studies have found the late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) was independently associated with ventricular arrhythmia (VA) in HCM. This study was conducted to determine whether the scar heterogeneity from LGE-derived entropy is associated with the VAs in HCM patients

Methods

Results

Conclusion