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• W4377015864 abstract "Hypertrophic cardiomyopathy (HCM) patients with extensive cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) are at greater risk of ventricular arrhythmias and sudden cardiac death (SCD). LGE-CMRs enable to identify dense fibrosis (core), diffuse fibrosis (border zone; BZ), and corridors of BZ tissue connecting areas of normal myocardium between core zones (BZ channels). These channels are essential components of reentry circuits and may promote VT/VF. We conducted a retrospective analysis of a cohort of consecutive HCM patients. We sought to describe scar architecture and assess scar composition as a predictor of VT/VF. We analyzed CMR images, generated LGE color-coded pixel signal intensity (PSI) maps using ADAS 3D software (Galgo Medical), and characterized hyper-enhanced areas as core zone, BZ, and healthy tissue. BZ channels were identified as corridors of BZ tissue surrounded by scar core or anatomical barriers. The study endpoint (VT/VF) was composed by SCD, cardiac arrest, prolonged VTs, or appropriate ICD therapy. Cox multivariable analyses were adjusted for major risk factors of SCD, including end-stage disease, apical aneurysm, and LV scar mass. 130 consecutive HCM patients (43±17 y; 73% males) were included. 15% had end-stage disease, 4.6% apical aneurysm and 58% had an ICD. Median LV mass was 147 g (IQR:108-201) and 86 patients (66%) had LGE. Median scar mass was 14.8g (IQR:6.3-32.8), or 9.7% (IQR:4.3-18.4) of LV mass. The scar was mainly composed of BZ tissue (median: 12.7g, IQR:5.5-28.0). Median core scar mass was 1.5g (IQR:0.2-3.8). 46 (35%) patients had BZ channels. During a median follow-up of 87 months (IQR:54-108), 18 (13.8%) patients had VT/VF. Scar mass (49.9 g, IQR:24.4-66.5 vs 12.3 g, IQR:3.3-26.7), BZ mass (37.7g, IQR:21.2-54.8 vs 10.7g, IQR:2.4-22.7) and core mass (5.7g, IQR:2.4-11.5 vs 1.3g, IQR:0.1-2.7) were significantly higher in VT/VF patients (p<0.01 for all comparisons) (Figure). BZ channels were observed in 83% of patients with VT/VF as compared with 28% of those without (p<0.01) (Figure). Median BZ channels mass was higher in VT/VF patients vs controls (1.9g, IQR:0.8-3.6 vs 0.0g, IQR:0.0-0.47; p<0.001). In multivariate analysis, BZ channels emerged as the best independent predictor of VT/VF (HR:7.0; 95%CI:1.9-25.4; p=0.003). In an unselected cohort of HCM patients, scar composition affected the risk of VT/VF. BZ channels emerged as a potent risk predictor beyond the magnitude of scar mass." @default.
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• W4377015864 date "2023-05-01" @default.
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• W4377015864 title "CE-452775-3 SCAR ARCHITECTURE AS A STRUCTURAL BIOMARKER OF VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: A CARDIAC MAGNETIC RESONANCE STUDY" @default.
• W4377015864 doi "https://doi.org/10.1016/j.hrthm.2023.03.297" @default.
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