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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
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Abstract
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3D architecture and arrhythmogenic potential of previous myocardial infarction scars
Session:
Painel 4 - Arritmologia 7
Speaker:
Pedro Freitas
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.3 Ventricular Arrhythmias and SCD - Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Pedro Freitas; António Ferreira; Diogo Cavaco; Gonçalo Lopes Da Cunha; Daniel Nascimento Matos; Gustavo Da Rocha Rodrigues; Carolina Padrão; Patrícia Santim; Ricardo Lopes; Afonso Grego; Fernando Marques; Telma Lima; João Carmo; Maria Salomé Carvalho; Ana Coutinho Santos; Anai Durazzo; Francisco Moscoso Costa; Pedro Lopes Do Carmo; Carla Rodrigues Carvalho; Francisco Bello Morgado; Pedro Adragão
Abstract
<p><strong>Background:</strong> The ability of left ventricular ejection fraction (LVEF) to correctly estimate the arrhythmic risk has been questioned. Recently, a method using 3D delayed enhancement cardiac magnetic resonance (CMR) identifies the potential arrhythmic substrate among scar tissue (border zone [BZ] channels).</p> <p><strong>Objective: </strong>to assess the prevalence of BZ channels in patients with previous MI and LVEF above and below the 35% threshold.</p> <p><strong>Methods: </strong>Patients with previous MI undergoing 1.5T CMR at a single center were prospectively enrolled from Dec/2017. The presence, mass, quality (scar core vs. BZ scar) were recorded as were the number and mass of BZ channels detected.</p> <p><strong>Results: </strong>A cohort of 51 patients (82% male, mean age 60 years) with previous MI and a high-quality 3D CMR dataset were enrolled. 49% (n = 25) had LVEF ≤ 35%. Table 1 compares the scar characteristics between the 2 groups. As expected, the number and mass of channels identified were correlated with the total scar burden (Spearman r >0.7, p < 0.001). Yet, no meaningful correlations were found between the number/mass of channels and scar heterogeneity (ratio BZ mass/scar mass) or LVEF. All patients with LVEF ≤ 35% had ≥ 1 channel detected, while 68% (n = 18) had ≥ 1 channel identified in the LVEF > 35% group. During a median follow-up of 11 months, 2 events were recorded (1 SCD and 1 appropriate ICD discharge). Both occurred in patients with LVEF ≤35% with an increased number of channels detected (13 and 6, respectively).</p> <p><strong>Conclusion: </strong>BZ channels are highly prevalent in patients with previous MI, even when LVEF > 35%. This finding suggests that the mere presence of BZ channels will probably be insufficient to identify patients at high-risk for arrhythmic events.</p>
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