Value of myocardial scar in predicting malignant ventricular arrhythmia in patients with chronic myocardial infarction

doi:10.3785/j.issn.1008-9292.2019.10.08

J Zhejiang Univ (Med Sci)

2019, Vol. 48

Issue (5): 511-516 DOI: 10.3785/j.issn.1008-9292.2019.10.08

Value of myocardial scar in predicting malignant ventricular arrhythmia in patients with chronic myocardial infarction

GUO Danling¹(

),HU Hongjie^2,*(

),ZHAO Zhenhua^1,*(

),LYU Sangying¹,HUANG Yanan¹,JIANG Ruhong³,PU Cailing²,NI Hongxia¹

1. Department of Radiology, Shaoxing People's Hospital, Shaoxing 312000, Zhejiang Province, China
2. Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
3. Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China

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Abstract

Objective: To assess the predictive value of myocardial scar mass in malignant ventricular arrhythmia (MVA) after myocardial infarction. Methods: Thirty myocardial infarction patients with complete electrophysiology and cardiac MRI data admitted from January 2012 to August 2017 were enrolled in the study. According to the results of intracavitary electrophysiological study, MVA developed in 16 patients (MVA group) and not developed in 14 patients (non-MVA group). The qualitative and quantitative analysis of left ventricular ejection fraction (LVFE) and scar mass was performed with CV^I42 post-processing software and predictive value of myocardial scar and LVEF for MVA after myocardial infarction was analyzed using ROC curves. Results: LVEF in MVA group was significantly lower than that in non-MVA group, and scar mass in MVA group was significantly higher than that in non-MVA group (all P < 0.05). Regression analysis showed that LVEF (OR=1.580) and scar mass (OR=6.270) were risk factors for MVA after myocardial infarction. For predicting MVA, the area under ROC curve (AUC) of LVEF was 0.696 with a sensitivity of 0.786 and the specificity of 0.685; the AUC of the scar mass was 0.839 with a sensitivity was 0.618 and the specificity of 0.929; the AUC of LVEF combined with scar mass was 0.848 with a sensitivity of 0.688 and specificity of 0.857. Conclusion: Myocardial scar assessed by late gadolinium enhancement MRI is more effective than LVEF in predicting MVA after myocardial infarction.

Key words： Myocardial infarction Magnetic resonance imaging Arrhythmias, cardiac/diagnosis Ventricular function, left Myocardium/pathology Cicatrix Forecasting

Received: 05 May 2019 Published: 04 January 2020

CLC:	R445.2
	R542.2+2

Corresponding Authors: HU Hongjie,ZHAO Zhenhua E-mail: 494429508@qq.com;hongjiehu@zju.edu.en;zhao2075@163.com

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	GUO Danling
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	ZHAO Zhenhua
	LYU Sangying
	HUANG Yanan
	JIANG Ruhong
	PU Cailing
	NI Hongxia

Cite this article:

GUO Danling,HU Hongjie,ZHAO Zhenhua,LYU Sangying,HUANG Yanan,JIANG Ruhong,PU Cailing,NI Hongxia. Value of myocardial scar in predicting malignant ventricular arrhythmia in patients with chronic myocardial infarction. J Zhejiang Univ (Med Sci), 2019, 48(5): 511-516.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.10.08 OR http://www.zjujournals.com/med/Y2019/V48/I5/511

心肌瘢痕对慢性心肌梗死后恶性室性心律失常发生的预测价值

目的: 分析心脏磁共振延迟强化量化的心肌瘢痕质量对慢性心肌梗死后恶性心律失常（MVA）发生的预测价值。方法: 选取2012年1月至2017年8月浙江大学医学院附属邵逸夫医院有完整腔内电生理及心脏磁共振资料的心肌梗死患者30例，根据腔内电生理检查结果分为两组：诱发出MVA组（16例）及未诱发出MVA组（14例）。通过CVI⁴²后处理软件对左心室射血分数（LVEF）及延迟强化评估的心肌瘢痕进行定性及定量分析，ROC曲线分析比较心肌瘢痕与LVEF对心肌梗死后MVA的预测价值。结果: 诱发出MVA组LVEF明显低于未诱发出MVA组，延迟强化评估的瘢痕质量也更大（均P < 0.05）。回归分析发现，心肌瘢痕质量及LVEF为心肌梗死后MVA发生的风险因子（OR=6.270和1.580）。ROC曲线分析结果显示，LVEF预测心肌梗死后MVA的AUC为0.696，敏感度为0.786，特异度为0.685；瘢痕质量预测心肌梗死后恶性室性心律失常的AUC为0.839，敏感度为0.618，特异度为0.929；LVEF与瘢痕质量两个指标联合预测心肌梗死后MVA的AUC为0.848，敏感度为0.688，特异度为0.857。结论: 心肌瘢痕对预测心肌梗死后MVA发生的效能较LVEF更高，有望成为心肌梗死后患者预后评估的另一项预测指标。

关键词： 心肌梗死/病理生理学, 磁共振成像, 心律失常, 心性/诊断, 心室功能, 左, 心肌/病理学, 瘢痕, 预测

Tab 1 Baseline characteristics between patients with or without MVA [$\bar x \pm s$或n(%)]

Tab 2 Left ventricular function and myocardial quality of patients with or without MVA ($\bar x \pm s$)

Tab 3 Late gadolinium enhanced parameters of patients with or without MVA ($\bar x \pm s$)

Tab 4 Multivariate logistic regression analysis of risk factors related to malignant ventricular tachyarrhythmia in patients with myocardial infarction

Fig 1 ROC curves of left ventricular ejection fraction and scar quality in predicting malignant ventricular arrhythmia


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