Utility of Computed Tomography to Predict Ventricular Arrhythmias in Patients With Nonischemic Cardiomyopathy Receiving Cardiac Resynchronization Therapy

Abstract

The residual risk of ventricular arrhythmia (VA) after cardiac resynchronization therapy (CRT) implantation in patients with nonischemic cardiomyopathy (NICM) remains difficult to evaluate. The impact of left ventricular (LV) wall thickness (WT) measured using computed tomography (CT) on the occurrence of VA after CRT implantation has never been investigated. In this pilot study, we examined the association of LV WT and the occurrence of VA in NICM patients receiving CRT. Thirty three patients with NICM scheduled for CRT underwent preprocedural CT. Reduced LV WT was defined as WT <6 mm and quantified as a percentage of total LV area. The end point was the occurrence of VA episode during 2-years follow-up after CRT implantation. During the 2-years follow-up, a total of 37 VA episodes occurred in 6 (18.2%) patients. Patients with VA exhibited significantly higher NT-pro BNP level before CRT implantation. Additionally, CT analysis showed that patients with VA had a higher percentage of total LV with reduced WT compared with those free from VA (49.5% vs 25.8%, respectively; p = 0.005). In multivariable analysis, the total percentage of LV area with WT <6 mm was the only predictor of VA (odds ratio 1.07 [1.00 to 1.14]; p = 0.047). Receiver-operator curves analysis for total percentage of LVWT <6 mm demonstrated that an optimal cut-off value of 40% differentiated patients at risk of VA. In conclusion, LVWT evaluated using cardiac CT is an independent predictor of VA in NICM patients implanted with CRT. Patients with a total percentage of LVWT <6 mm ≥40% are especially at high risk of VA after CRT implantation.