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ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease
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J Am Coll Cardiol, 2005; 45:1104-1108, doi:10.1016/j.jacc.2004.12.057
© 2005 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CARDIAC MAGNETIC RESONANCE

Infarct morphology identifies patients with substrate for sustained ventricular tachycardia

David Bello, MD, David S. Fieno, PhD, Raymond J. Kim, MD, F. Scott Pereles, MD, Rod Passman, MD, FACC, Gina Song, BA, Alan H. Kadish, MD, FACC and Jeffrey J. Goldberger, MD, FACC*

Department of Medicine, Divisions of Cardiology and Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois

Manuscript received July 2, 2004; accepted December 14, 2004.

* Reprint requests and correspondence: Dr. Jeffrey J. Goldberger, Feinberg School of Medicine, Northwestern University, Division of Cardiac Electrophysiology, 251 East Huron, Feinberg Pavilion 8-542, Chicago, Illinois 60611 (Email: j-goldberger{at}northwestern.edu).

OBJECTIVES: We sought to evaluate whether infarct size characterization by cardiac magnetic resonance imaging (MRI) is a better predictor of inducible ventricular tachycardia (VT) than left ventricular ejection fraction (LVEF).

BACKGROUND: Inducibility of VT at electrophysiologic study (EPS) and low LVEF can identify patients with a substrate for VT. Magnetic resonance imaging has been shown to identify, with high precision, areas of myocardial infarction and may therefore be a better tool to evaluate for a substrate for VT.

METHODS: We studied 48 patients with known coronary artery disease who were referred for EPS using cine and gadolinium-enhanced MRI. Wall motion and infarct characteristics were determined blindly and compared among patients with no inducible ventricular arrhythmias (n = 21), those with inducible monomorphic VT (MVT, n = 18), and those with either inducible polymorphic VT or ventricular fibrillation (n = 9).

RESULTS: Patients with MVT had larger infarcts than patients who did not have inducible arrhythmias (mass: 49 ± 5 g [SE] vs. 28 ± 5 g, p < 0.005; surface area: 172 ± 15 cm2 vs. 93 ± 14 cm2, p < 0.0005). Patients with polymorphic VT/fibrillation had intermediate values (mass: 36 ± 7 g; surface area: 115 ± 22 cm2). Ejection fraction was inversely related to infarct mass and surface area, with R2 values ranging from 0.21 to 0.27. Logistic regression and receiver-operating characteristic analysis demonstrated that infarct mass and surface area were better predictors of inducibility of MVT than LVEF.

CONCLUSIONS: Infarct surface area and mass, as measured by cardiac MRI, are better identifiers of patients who have a substrate for MVT than LVEF. Further evaluation of infarct size characterization by cardiac MRI as a predictor of sudden cardiac death is warranted.

Abbreviations and Acronyms
  CAD = coronary artery disease
  ceMRI = contrast-enhanced magnetic resonance imaging
  EPS = electrophysiologic study
  LVEF = left ventricular ejection fraction
  MRI = magnetic resonance imaging
  MVT = monomorphic ventricular tachycardia
  PVT = polymorphic ventricular tachycardia
  ROC = receiver-operating characteristic
  VF = ventricular fibrillation
  VT = ventricular tachycardia




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