scholarly journals Myocardial Fibrosis Identified by Cardiac Magnetic Resonance Late Gadolinium Enhancement Is Associated With Adverse Ventricular Mechanics and Ventricular Tachycardia Late After Fontan Operation

2010 ◽  
Vol 55 (16) ◽  
pp. 1721-1728 ◽  
Author(s):  
Rahul H. Rathod ◽  
Ashwin Prakash ◽  
Andrew J. Powell ◽  
Tal Geva
Keyword(s):  
Ventricular Tachycardia ◽  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Myocardial Fibrosis ◽  
Fontan Operation ◽  
Gadolinium Enhancement ◽  
Ventricular Mechanics

Agreement between gadolinium-enhanced cardiac magnetic resonance and electro-anatomical maps in patients with non-ischaemic dilated cardiomyopathy and ventricular arrhythmias

EP Europace ◽  
2019 ◽  
Vol 21 (9) ◽  
pp. 1392-1399
Author(s):  
Federica Torri ◽  
Csilla Czimbalmos ◽  
Livio Bertagnolli ◽  
Sabrina Oebel ◽  
Andreas Bollmann ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Dilated Cardiomyopathy ◽  
Ventricular Arrhythmias ◽  
Low Voltage ◽  
Gadolinium Enhancement ◽  
Lge Cmr ◽  
Good Agreement

Abstract Aims We sought to investigate the overlap between late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) and electro-anatomical maps (EAM) of patients with non-ischaemic dilated cardiomyopathy (NIDCM) and how it relates with the outcomes after catheter ablation of ventricular arrhythmias (VA). Methods and results We identified 50 patients with NIDCM who received CMR and ablation for VA. Late gadolinium enhancement was detected in 16 (32%) patients, mostly in those presenting with sustained ventricular tachycardia (VT): 15 patients. Low-voltage areas (<1.5 mV) were observed in 23 (46%) cases; in 7 (14%) cases without evidence of LGE. Using a threshold of 1.5 mV, a good and partially good agreement between the bipolar EAM and LGE-CMR was observed in only 4 (8%) and 9 (18%) patients, respectively. With further adjustments of EAM to match the LGE, we defined new cut-off limits of median 1.5 and 5 mV for bipolar and unipolar maps, respectively. Most VT exits (12 out of 16 patients) were found in areas with LGE. VT exits were found in segments without LGE in two patients with VT recurrence as well as in two patients without recurrence, P = 0.77. In patients with VT recurrence, the LGE volume was significantly larger than in those without recurrence: 12% ± 5.8% vs. 6.9% ± 3.4%; P = 0.049. Conclusions In NIDCM, the agreement between LGE and bipolar EAM was fairly poor but can be improved with adjustment of the thresholds for EAM according to the amount of LGE. The outcomes were related to the volume of LGE.

Arrhythmogenic substrate detection in chronic ischaemic patients undergoing ventricular tachycardia ablation using multidetector cardiac computed tomography: compared evaluation with cardiac magnetic resonance

EP Europace ◽  
2020 ◽  
Author(s):  
Beatriz Jáuregui ◽  
David Soto-Iglesias ◽  
Giulio Zucchelli ◽  
Diego Penela ◽  
Augusto Ordóñez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ventricular Tachycardia ◽  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Cardiac Computed Tomography ◽  
Left Ventricular Ejection ◽  
Gadolinium Enhancement ◽  
Arrhythmogenic Substrate ◽  
Lge Cmr

Abstract Aims Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) permits characterizing ischaemic scars, detecting heterogeneous tissue channels (HTCs) which constitute the arrhythmogenic substrate (AS). Late gadolinium enhancement cardiac magnetic resonance also improves the arrhythmia-free survival when used to guide ventricular tachycardia (VT) substrate ablation. However, its availability may be limited. We sought to evaluate the performance of multidetector cardiac computed tomography (MDCT) imaging in identifying HTCs detected by LGE-CMR in ischaemic patients undergoing VT substrate ablation. Methods and results Thirty ischaemic patients undergoing both LGE-CMR and MDCT before VT substrate ablation were included. Using a dedicated post-processing software, two blinded operators, assigned either to LGE-CMR or MDCT analysis, characterized the presence of CMR and computed tomography (CT) channels, respectively. Cardiac magnetic resonance channels were classified as endocardial (layers &lt; 50%), epicardial (layers ≥ 50%), or transmural. Cardiac magnetic resonance- vs. CT-channel concordance was considered when showing the same orientation and American Heart Association (AHA) segment. Mean age was 69 ± 10 years; 90% were male. Mean left ventricular ejection fraction was 35 ± 10%. All patients had CMR channels (n = 76), whereas only 26/30 (86.7%) had CT channels (n = 91). Global sensitivity (Se) and positive predictive values for detecting CMR channels were 61.8% and 51.6%, respectively. MDCT performance improved in patients with epicardial CMR channels (Se 80.5%) and transmural scars (Se 72.2%). In 4/11 (36%) patients with subendocardial myocardial infarction (MI), MDCT was unable to identify the AS. Conclusions Compared to LGE-CMR, myocardial wall thickness assessment using MDCT fails to detect the presence of AS in 36% of patients with subendocardial MI, showing modest sensitivity identifying HTCs but a better performance in patients with transmural scars.

P1867Diagnostic value of fragmented QRS complex and early repolarization pattern in detecting myocardial fibrosis and inflammatory

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Gordeeva ◽  
V Karlina ◽  
E Parmon ◽  
E Shlyakhto
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Myocardial Fibrosis ◽  
Endomyocardial Biopsy ◽  
Qrs Complex ◽  
Gadolinium Enhancement ◽  
Early Repolarization ◽  
Fragmented Qrs ◽  
Sensitivity Specificity

Abstract Myocardial fibrosis (MF) and inflammatory (MI) play a significant role in pathogenesis of arrhythmias, heart failure and sudden cardiac death. Endomyocardial biopsy (EMB) and cardiac magnetic resonance with late gadolinium enhancement (CMRI-LGE) are used to detect this structural abnormalities. These methods are very informative but not a screening. ECG patterns: fragmented QRS complex (fQRS) and early repolarization (ERP) can be used as markers of MF and MI. Purpose To analyze the relationship between structural changes of myocardium, determined using by CMRI-LGE and EMB and fQRS and ERP. Materials and methods We analyzed results of CMRI-LG, EMB and 12-lead ECG in 46 patients (28 male, median age – 47.3±12.7). We used the criteria by Das M., 2006 to identify FQRS and the criteria by Macfarlane P.W., 2015 to identify ERP. Results Based on the results of CMRI-LGE and EMB all patients were divided into 3 groups: 1st – 20 patients (70% male, median age 56 (48.5; 58.5)) with acute inflammatory (more then 14 leucocytes per mm2) and myocardial fibrosis (detecting by EMB and/or CMRI-LGE); 2nd group – 20 patients (65% male, median age 37 (28.0; 49.5)) with myocardial fibrosis without inflammatory changes; 3rd group – 6 patients without fibrosis or inflammatory. In the 1st group fQRS were detected in 7 (35%) patients, ERP – 6 (30%). In the 2nd group fQRS were detected in 5 (25%) patients, ERP – 6 (0%). In the 3rd group fQRS were not detected in 7 (35%) patients, ERP – 6 (30%). We assessed sensitivity and specificity of fQRS and ERP in detected MF and MI by comparing with CMRI-LGE and EMB (table 1). Sensitivity and specificity ECG patterns Myocardial fibrosis Myocardial inflammatory ECG pattern Method Sensitivity Specificity ECG pattern Method Sensitivity Specificity FQRS EMB 76.9% 39.4% FQRS EMB 53.8% 63.6% MRI 83.3% 56.0% MRI 30.8% 84.0% ERP EMB 42.9% 30.8% ERP EMB 85.7% 66.7% MRI 50.0% 41.9% MRI 33.3% 81.3% FQRS, fragmented QRS; ERP, early repolarization pattern; EMB, endomyocardial biopsy; MRI, cardiac magnetic resonance with late gadolinium enhancement. Conclusions FQRS have significant sensitivity (83.3%) and specificity (56%) for detecting MF. And ERP has significant sensitivity (85.7%) and specificity (66.7%) for detecting MI. This ECG patterns could be discussed as screening markers of structural myocardial abnormalities.

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