Cardiovascular magnetic resonance determinants of ventricular arrhythmic events after myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) permits to identify the arrhythmogenic substrate in chronic post-myocardial infarction (MI) patients. It is unknown why a minority of chronic post-MI patients develop sustained ventricular tachycardias (VT) over follow-up, regardless of their left ventricular ejection fraction (LVEF). Objectives To noninvasively characterize scar differences and potential predictors of VT occurrence in chronic post-MI patients. Methods A case-control study was designed through retrospective LGE-CMR data analysis of chronic post-MI patients i) consecutively referred for VT substrate ablation after a first VT episode (n = 66), and ii) from a control group (n = 84) with no arrhythmia evidence. The myocardium was characterized differentiating core, border zone (BZ) and BZ channels (BZC) using the ADAS 3D post-processing imaging platform. Clinical and scar characteristics, including a novel parameter, the BZC mass, were compared between both groups. Results 150 post-MI patients were included for analysis. Four multivariate Cox proportional hazards regression models were created for total scar mass (model 1), BZ mass (model 2), core mass (model 3), and BZC mass (model 4, see table). All of them were adjusted by age, sex, and LVEF. In the corresponding models, only total scar mass, BZ mass, core mass, and BZC mass were independent variables associated with the development of VT. BZC mass showed the best performance: a cut-off of 5.15 g identified the cases with 92.4% sensitivity and 86.9% specificity [AUC 0.93 (0.89–0.97); p