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Browsing by Author "Pasquale, Ferdinando"

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  • Arrhythmic risk stratification in patients with left ventricular ring-like scar
    Publication . Parisi, Vanda; Graziosi, Maddalena; Lopes, Luis R.; Luca, Antonio De; Pasquale, Ferdinando; Tini, Giacomo; Targetti, Mattia; Cueto, Maria R.; Moura, Ana R.; Ditaranto, Raffaello; Torlasco, Camilla; Taglieri, Nevio; Nardi, Elena; Lovato, Luigi; Augusto, João B.; Galiè, Nazzareno; Crotti, Lia; Gasperetti, Alessio; Biffi, Mauro; Autore, Camillo; Merlo, Marco; Olivotto, Iacopo; Sinagra, Gianfranco; Elliott, Perry M.; Biagini, Elena
    Aims Left ventricular (LV) ring-like scar on cardiac magnetic resonance (CMR) has been linked to malignant arrhythmias in patients with non-ischaemic cardiomyopathy. This study aimed to perform a comprehensive evaluation of this phenotype and to identify risk factors for life-threatening arrhythmic events (LAEs), a composite of sudden cardiac death (SCD), aborted SCD, and sustained ventricular tachycardia. Methods and results One hundred and fifteen patients [median age 39 (interquartile range, IQR, 28–52), 42% females] were identified at 6 referral centres. Inclusion criteria were ring-like LV scar [≥3 contiguous segments with sub-epicardial/midwall late gadolinium enhancement (LGE) in the same slice] and one among: pathogenic/likely pathogenic genetic variant, family history for cardiomyopathy, or arrhythmogenic cardiomyopathy diagnosis. During the study follow-up, survival free from LAEs was 60% (3.8 events/100 patients/year); at a median follow-up of 4.6 years (IQR 1.7–8.4) it was 84%. On multivariable analysis, anterior Q waves [hazard ratio (HR): 1.030, 95% confidence intervals (CI): 1.014–1.046, P < 0.001], QRS width (HR: 4.642, 95% CI: 1.296–16.628, P = 0.018), and LV end-diastolic volume index (LVEDVi; HR: 1.011, 95% CI: 1.001–1.021, per mL/m2 increase, P = 0.040) were independently associated with LAEs; with good discrimination power (Harrell’s C-index = 0.796). Three risk categories were identified: normal electrocardiogram (ECG), abnormal ECG and no LAEs predictive variables, abnormal ECG and ≥1 LAEs predictive variables, with a decreasing survival from 100 to 65% and 49%, respectively (Log-rank test = 0.015). Conclusion In this study, the LV ring-like scar phenotype was associated with a high rate of malignant arrhythmias in presence of anterior Q waves, QRS prolongation, and increased LVEDVi. A normal ECG identified a lower risk sub-group.
    2024-11-14Journal article Open access Show more