Myocardial fibrosis predicts ventricular tachyarrhythmias

• Published in: Trends in cardiovascular medicine Vol. 27; no. 5; pp. 363 - 372
• Main Authors: Disertori, Marcello, Masè, Michela, Ravelli, Flavia
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2017; Elsevier Limited
• Subjects: Animals; Arrhythmias; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - therapy; Biomarkers; Biopsy; Cardiac arrhythmia; Cardiomyopathies - complications; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - physiopathology; Cardiomyopathies - therapy; Cardiomyopathy; Cardiovascular; Cardiovascular disease; Cardiovascular diseases; Collagen; Coronary artery disease; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - prevention & control; Decision making; Defibrillators; Defibrillators, Implantable; Dilated cardiomyopathy; Disease prevention; Electric Countershock - instrumentation; Electrocardiography; Fibroblasts; Fibrosis; Gadolinium; Heart attacks; Heart diseases; Heart failure; Heart Rate; Humans; Implantable cardioverter-defibrillator; Ischemia; Late gadolinium enhancement; Magnetic Resonance Imaging; Medical imaging; Myocardium - pathology; Predictive Value of Tests; Risk Factors; Scars; Sudden cardiac death; Treatment Outcome; Ventricle; Ventricular Function; fibrosis; late gadolinium enhancement; sudden cardiac death; cardiomyopathy; Arrhythmias; implantable cardioverter-defibrillator; Sudden cardiac death; Cardiomyopathy; Late gadolinium enhancement; Implantable cardioverter-defibrillator; Fibrosis
• ISSN: 1050-1738; 1873-2615
• DOI: 10.1016/j.tcm.2017.01.011

Abstract Myocardial fibrosis is a common pattern in the setting of different heart diseases, and promotes ventricular tachyarrhythmias by creating a vulnerable substrate for reentrant activity and by favoring the emergence of triggers. Currently, late gadolinium enhancement (LGE) cardiac magnetic resonance is considered the reference method for the noninvasive assessment of ventricular fibrosis. Several studies and meta-analyses have shown that ventricular fibrosis detected by LGE is a powerful predictor of ventricular tachyarrhythmic events in ischemic, non-ischemic dilated cardiomyopathy and hypertrophic cardiomyopathy patients. Both the presence and extension of ventricular fibrosis were shown to correlate with the occurrence of ventricular arrhythmias and sudden cardiac death, irrespective of the grade of left ventricular dysfunction. Based on these results, the assessment of ventricular fibrosis has been suggested as a candidate marker to improve the decision making for implantable cardioverter-defibrillator therapy in patients with left ventricular dysfunction. These points will be discussed in the review.