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Arrhythmic risk stratification in patients with left ventricular ring-like scar

2024-11-14Journal article Open access
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dc.contributor.authorParisi, Vanda
dc.contributor.authorGraziosi, Maddalena
dc.contributor.authorLopes, Luis R.
dc.contributor.authorLuca, Antonio De
dc.contributor.authorPasquale, Ferdinando
dc.contributor.authorTini, Giacomo
dc.contributor.authorTargetti, Mattia
dc.contributor.authorCueto, Maria R.
dc.contributor.authorMoura, Ana R.
dc.contributor.authorDitaranto, Raffaello
dc.contributor.authorTorlasco, Camilla
dc.contributor.authorTaglieri, Nevio
dc.contributor.authorNardi, Elena
dc.contributor.authorLovato, Luigi
dc.contributor.authorAugusto, João B.
dc.contributor.authorGaliè, Nazzareno
dc.contributor.authorCrotti, Lia
dc.contributor.authorGasperetti, Alessio
dc.contributor.authorBiffi, Mauro
dc.contributor.authorAutore, Camillo
dc.contributor.authorMerlo, Marco
dc.contributor.authorOlivotto, Iacopo
dc.contributor.authorSinagra, Gianfranco
dc.contributor.authorElliott, Perry M.
dc.contributor.authorBiagini, Elena
dc.date.accessioned2024-11-26T14:08:00Z
dc.date.available2024-11-26T14:08:00Z
dc.date.issued2024-11-14
dc.description.abstractAims 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.doi10.1093/eurjpc/zwae353pt_PT
dc.identifier.issn2047-4873
dc.identifier.pmid39486037
dc.identifier.urihttp://hdl.handle.net/10400.14/47296
dc.identifier.wos001354075800001
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/pt_PT
dc.subjectArrhythmiaspt_PT
dc.subjectCardiac magnetic resonancept_PT
dc.subjectCardiomyopathypt_PT
dc.subjectElectrocardiogrampt_PT
dc.subjectPrognosispt_PT
dc.subjectRing-like scarpt_PT
dc.subjectRisk stratificationpt_PT
dc.titleArrhythmic risk stratification in patients with left ventricular ring-like scarpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.titleEuropean Journal of Preventive Cardiologypt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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