| Title: |
Arrhythmic risk stratification in patients with left ventricular ring-like scar |
| Authors: |
Parisi V.; Graziosi M.; Lopes L. R.; De Luca A.; Pasquale F.; Tini G.; Targetti M.; Cueto M. R.; Moura A. R.; Ditaranto R.; Torlasco C.; Taglieri N.; Nardi E.; Lovato L.; Augusto J. B.; Galie N.; Crotti L.; Gasperetti A.; Biffi M.; Autore C.; Merlo M.; Olivotto I.; Sinagra G.; Elliott P. M.; Biagini E. |
| Contributors: |
Parisi, V; Graziosi, M; Lopes, L; De Luca, A; Pasquale, F; Tini, G; Targetti, M; Cueto, M; Moura, A; Ditaranto, R; Torlasco, C; Taglieri, N; Nardi, E; Lovato, L; Augusto, J; Galie, N; Crotti, L; Gasperetti, A; Biffi, M; Autore, C; Merlo, M; Olivotto, I; Sinagra, G; Elliott, P; Biagini, E |
| Publisher Information: |
GB; Oxford University Press |
| Publication Year: |
2025 |
| Collection: |
Università degli Studi di Milano-Bicocca: BOA (Bicocca Open Archive) |
| Subject Terms: |
Arrhythmia; Cardiac magnetic resonance; Cardiomyopathy; Electrocardiogram; Prognosi; Ring-like scar; Risk stratification |
| Description: |
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 One hundred and fifteen patients [median age 39 (interquartile range, IQR, 28–52), 42% females] were identified at 6 referral and results 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. |
| Document Type: |
article in journal/newspaper |
| File Description: |
STAMPA |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/39486037; info:eu-repo/semantics/altIdentifier/wos/WOS:001354075800001; volume:32; issue:12; firstpage:1064; lastpage:1074; numberofpages:11; journal:EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY; https://hdl.handle.net/10281/595908 |
| DOI: |
10.1093/eurjpc/zwae353 |
| Availability: |
https://hdl.handle.net/10281/595908; https://doi.org/10.1093/eurjpc/zwae353 |
| Rights: |
info:eu-repo/semantics/openAccess ; license:Creative Commons ; license uri:http://creativecommons.org/licenses/by-nc/4.0/ |
| Accession Number: |
edsbas.23D322B2 |
| Database: |
BASE |