Myocardial Fibrosis as a Predictor of Sudden Death in Patients With Coronary Artery Disease,Journal of the American College of Cardiology

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Myocardial Fibrosis as a Predictor of Sudden Death in Patients With Coronary Artery Disease
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2021-01-01 , DOI: 10.1016/j.jacc.2020.10.046
Abbasin Zegard ₁ , Osita Okafor ₁ , Joseph de Bono ₂ , Manish Kalla ₂ , Mauro Lencioni ₂ , Howard Marshall ₂ , Lucy Hudsmith ₂ , Tian Qiu ₃ , Richard Steeds ₂ , Berthold Stegemann ₃ , Francisco Leyva ₃

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BACKGROUND The "gray zone" of myocardial fibrosis (GZF) on cardiovascular magnetic resonance may be a substrate for ventricular arrhythmias (VAs). OBJECTIVES The purpose of this study was to determine whether GZF predicts sudden cardiac death (SCD) and VAs (ventricular fibrillation or sustained ventricular tachycardia) in patients with coronary artery disease (CAD) and a wide range of left ventricular ejection fractions (LVEFs). METHODS In this retrospective study of CAD patients, the presence of myocardial fibrosis on visual assessment (MFVA) and GZF mass in patients with MFVA were assessed in relation to SCD and the composite, arrhythmic endpoint of SCD or VAs. RESULTS Among 979 patients (mean age [± SD]: 65.8 ± 12.3 years), 29 (2.96%) experienced SCD and 80 (8.17%) met the arrhythmic endpoint over median 5.82 years (interquartile range: 4.1 to 7.3 years). In the whole cohort, MFVA was strongly associated with SCD (hazard ratio: 10.1; 95% confidence interval [CI]: 1.42 to 1,278.9) and the arrhythmic endpoint (hazard ratio: 28.0; 95% CI: 4.07 to 3,525.4). In competing risks analyses, associations between LVEF <35% and SCD (subdistribution hazard ratio [sHR]: 2.99; 95% CI: 1.42 to 6.31) and the arrhythmic endpoint (sHR: 4.71; 95% CI: 2.97 to 7.47) were weaker. In competing risk analyses of the MFVA subcohort (n = 832), GZF using the 3SD method (GZF3SD) >5.0 g was strongly associated with SCD (sHR: 10.8; 95% CI: 3.74 to 30.9) and the arrhythmic endpoint (sHR: 7.40; 95% CI: 4.29 to 12.8). Associations between LVEF <35% and SCD (sHR: 2.62; 95% CI: 1.24 to 5.52) and the arrhythmic endpoint (sHR: 4.14; 95% CI: 2.61 to 6.57) were weaker. CONCLUSIONS In CAD patients, MFVA plus quantified GZF3SD mass was more strongly associated with SCD and VAs than LVEF. In selecting patients for implantable cardioverter-defibrillators, assessment of MFVA followed by quantification of GZF3SD mass may be preferable to LVEF.

中文翻译：

心肌纤维化可作为冠心病患者猝死的预测指标

背景心血管磁共振上心肌纤维化（GZF）的“灰色地带”可能是室性心律失常（VA）的基础。目的本研究的目的是确定 GZF 是否可以预测患有冠状动脉疾病 (CAD) 和各种左心室射血分数 (LVEF) 的患者的心源性猝死 (SCD) 和 VAs（心室颤动或持续性室性心动过速）。方法在这项对 CAD 患者的回顾性研究中，评估了肉眼评估 (MFVA) 和 MFVA 患者中心肌纤维化的存在与 SCD 以及 SCD 或 VA 的复合、心律失常终点的关系。结果在 979 名患者（平均年龄 [± SD]：65.8 ± 12.3 岁）中，29 名（2.96%）经历了 SCD，80 名（8.17%）达到了超过中位数 5 的心律失常终点。82 岁（四分位距：4.1 至 7.3 岁）。在整个队列中，MFVA 与 SCD（风险比：10.1；95% 置信区间 [CI]：1.42 至 1,278.9）和心律失常终点（风险比：28.0；95% CI：4.07 至 3,525.4）密切相关。在竞争风险分析中，LVEF <35% 与 SCD（亚分布风险比 [sHR]：2.99；95% CI：1.42 至 6.31）与心律失常终点（sHR：4.71；95% CI：2.97 至 7.47）之间的关联较弱. 在 MFVA 亚组（n = 832）的竞争风险分析中，使用 3SD 方法（GZF3SD）>5.0 g 的 GZF 与 SCD（sHR：10.8；95% CI：3.74 至 30.9）和心律失常终点（sHR： 7.40；95% CI：4.29 至 12.8)。LVEF <35% 与 SCD（sHR：2.62；95% CI：1.24 至 5.52）与心律失常终点（sHR：4.14；95% CI：2.61 至 6.57）之间的关联较弱。结论在 CAD 患者中，MFVA 加上量化的 GZF3SD 质量与 SCD 和 VA 的相关性比 LVEF 更强。在选择植入式心律转复除颤器的患者时，评估 MFVA 然后量化 GZF3SD 质量可能优于 LVEF。

更新日期：2021-01-01

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