Usefulness of cardiac magnetic resonance in assessing the risk of ventricular arrhythmias and sudden death in patients with hypertrophic cardiomyopathy
Sergio Leonardi1, Claudia Raineri1,*, Gaetano M. De Ferrari1, Stefano Ghio1, Laura Scelsi1, Michele Pasotti2, Marilena Tagliani2, Adele Valentini3, Roberto Dore3, Arturo Raisaro1 and Eloisa Arbustini2Aims: To assess the relationship between cardiovascular magnetic resonance (CMR) parameters and both spontaneous ventricular tachycardia (VT) and risk of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) patients.
Methods and results: One hundred and eight consecutive HCM patients (mean age 42 ± 15 years, 76% males) underwent CMR evaluation and risk assessment. Delayed contrast enhancement (DCE) was quantified with a specifically designed score. Endpoints were either the presence of clinical VT/ventricular fibrillation (VF) or of acknowledged risk factors for SCD. Compared to patients without arrhythmia, those with VT/VF (n = 33) had a higher DCE score [median 8 (2–13) vs. 11 (6–20); P = 0.01]; DCE score was also the only independent predictor of VT/VF in the multivariable model. DCE score [median 6 (1–10.5) vs. 12 (6–18); P = 0.001], mean and maximal left ventricular (LV) wall thickness (MaxLVWT), as well as LV mass index were significantly greater among patients at risk for SCD (n = 51) compared with the remaining 57 patients at low risk. DCE score and MaxLVWT were independent predictors of SCD risk.
Conclusion: In HCM patients several CMR parameters are associated with risk for SCD. A semi-quantitative index of DCE is a significant multivariable predictor of both clinical VT/VF and of risk for SCD and may contribute to risk assessment in borderline or controversial cases.
Conclusion: In HCM patients several CMR parameters are associated with risk for SCD. A semi-quantitative index of DCE is a significant multivariable predictor of both clinical VT/VF and of risk for SCD and may contribute to risk assessment in borderline or controversial cases.
Key Words: Cardiovascular magnetic resonance • Sudden cardiac death • Hypertrophic cardiomyopathy • Ventricular tachycardia/fibrillation.
European Heart Journal 2009 30(16):2003-2010
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Me parece que en la miocardiopatía hipertrofica la resonancia ocupa un lugar importante cuando el diagnóstico por eco no es definitivo. En las hipertrofias apicales o laterales donde el eco pierde definición es donde la RMC debe fundamentar su valor. Nosotros tuvimos varios diagnosticos de MH por RMC en pacientes que ingresan con cambios en el ECG y fueron erroneamente calsificados como infartos con coronarias normales.
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