Structural assessment of myocardial infarction scars and left ventricular function with cardiac magnetic resonance imaging in patients at high risk of sudden cardiac death.

Abstract

Results of qualitative and quantitative analyses of scars and LV (left ventricle) function acquired by means of cardiac magnetic resonance (CMR) were correlated with a subsequent occurrence of malignant ventricular arrhythmias in patients at high risk of sudden cardiac death (SCD). We have prospectively followed 47 patients (mean age 60 ± 11 years) who were hospitalized for an implantable cardioverter-defibrillator (ICD) implantation to prevent SCD. All post-MI patients had severe residual LV dysfunction (LVEF 33±14%). Patients were examined with CMR. Based on CMR analysis, we evaluated the basic functional parameters of LV as well as mass, volume, transmurality and heterogeneity of the post-MI scar. The patients with malignant arrhythmias were characterized by smaller LV end-diastolic diameters (LVED 192 ± 79 vs 254 ± 47 mm, p = 0.003) and end-systolic diameters (LVES 131 ± 80 vs 181 ± 45 mm, p = 0.01). As for the other observed functional and morphological CMR parameters, no significant differences between the two groups were detected. These results indicate that post-MI patients with severe residual left ventricular dysfunction and dilatation are in the long term characterized by a lower incidence of malignant arrhythmias compared to the patients with less dilated LV with a comparably severe LV dysfunction (Tab. 2, Fig. 3, Ref. 26). Text in PDF www.elis.sk.