Greyzone myocardial fibrosis and ventricular arrhythmias in patients with a left ventricular ejection fraction >35%

Abbasin Zegard; Osita Okafor; Joseph de Bono; Manish Kalla; Mauro Lencioni; Howard Marshall; Lucy Hudsmith; Tian Qiu; Richard Steeds; Berthold Stegemann; Francisco Leyva-Leon

doi:10.1093/europace/euab167

Greyzone myocardial fibrosis and ventricular arrhythmias in patients with a left ventricular ejection fraction >35%

Abbasin Zegard, Osita Okafor, Joseph de Bono, Manish Kalla, Mauro Lencioni, Howard Marshall, Lucy Hudsmith, Tian Qiu, Richard Steeds, Berthold Stegemann, Francisco Leyva-Leon^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

AIMS: To determine whether myocardial fibrosis and greyzone fibrosis (GZF) on cardiovascular magnetic resonance (CMR) is associated with ventricular arrhythmias in patients with coronary artery disease (CAD) and a left ventricular ejection fraction (LVEF) >35%.

METHODS AND RESULTS: In this retrospective study of CAD patients, GZF mass using the 3SD method (GZF3SD) and total fibrosis mass using the 2SD method (TF2SD) on CMR were assessed in relation to the primary, combined endpoint of sudden cardiac death, ventricular tachycardia, ventricular fibrillation, or resuscitated cardiac arrest. Among 701 patients [age: 65.8 ± 12.3 years (mean ± SD)], 28 (3.99%) patients met the primary endpoint over 5.91 years (median; interquartile range 4.42-7.64). In competing risks analysis, a GZF3SD mass ≥5.0 g was strongly associated with the primary endpoint [subdistribution hazard ratio (sHR): 17.4 (95% confidence interval, CI 6.64-45.5); area under receiver operator characteristic curve (AUC): 0.85, P < 0.001]. A weaker association was observed for TF2SD mass ≥23 g [sHR 10.4 (95% CI 4.22-25.8); AUC: 0.80, P < 0.001]. The range of sHRs for GZF3SD mass (1-527) was wider than for TF2SD mass (1-37.6).

CONCLUSIONS: In CAD patients with an LVEF >35%, GZF3SD mass was strongly associated with the arrhythmic endpoint. These findings hold promise for its use in identifying patients with CAD and an LVEF >35% at risk of arrhythmic events.

Original language	English
Pages (from-to)	31-39
Number of pages	9
Journal	Europace
Volume	24
Issue number	1
Early online date	11 Aug 2021
DOIs	https://doi.org/10.1093/europace/euab167
Publication status	Published - 4 Jan 2022

Bibliographical note

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Funding: We are grateful to Medtronic Plc and Boston Scientific for their support in funding this study, in the form of unrestricted educational grants.

Keywords

Cardiovascular magnetic resonance
Coronary artery disease
Greyzone scar
Myocardial fibrosis
Sudden cardiac death
Ventricular fibrillation
Ventricular tachycardia

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10.1093/europace/euab167Licence: CC BY-NC 3.0

Zegard et al Greyzone Myocardial Fibrosis
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Final published version, 915 KBLicence: CC BY-NC 3.0

Cite this

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title = "Greyzone myocardial fibrosis and ventricular arrhythmias in patients with a left ventricular ejection fraction >35%",

abstract = "AIMS: To determine whether myocardial fibrosis and greyzone fibrosis (GZF) on cardiovascular magnetic resonance (CMR) is associated with ventricular arrhythmias in patients with coronary artery disease (CAD) and a left ventricular ejection fraction (LVEF) >35%.METHODS AND RESULTS: In this retrospective study of CAD patients, GZF mass using the 3SD method (GZF3SD) and total fibrosis mass using the 2SD method (TF2SD) on CMR were assessed in relation to the primary, combined endpoint of sudden cardiac death, ventricular tachycardia, ventricular fibrillation, or resuscitated cardiac arrest. Among 701 patients [age: 65.8 ± 12.3 years (mean ± SD)], 28 (3.99%) patients met the primary endpoint over 5.91 years (median; interquartile range 4.42-7.64). In competing risks analysis, a GZF3SD mass ≥5.0 g was strongly associated with the primary endpoint [subdistribution hazard ratio (sHR): 17.4 (95% confidence interval, CI 6.64-45.5); area under receiver operator characteristic curve (AUC): 0.85, P < 0.001]. A weaker association was observed for TF2SD mass ≥23 g [sHR 10.4 (95% CI 4.22-25.8); AUC: 0.80, P < 0.001]. The range of sHRs for GZF3SD mass (1-527) was wider than for TF2SD mass (1-37.6).CONCLUSIONS: In CAD patients with an LVEF >35%, GZF3SD mass was strongly associated with the arrhythmic endpoint. These findings hold promise for its use in identifying patients with CAD and an LVEF >35% at risk of arrhythmic events.",

keywords = "Cardiovascular magnetic resonance, Coronary artery disease, Greyzone scar, Myocardial fibrosis, Sudden cardiac death, Ventricular fibrillation, Ventricular tachycardia",

author = "Abbasin Zegard and Osita Okafor and {de Bono}, Joseph and Manish Kalla and Mauro Lencioni and Howard Marshall and Lucy Hudsmith and Tian Qiu and Richard Steeds and Berthold Stegemann and Francisco Leyva-Leon",

note = "{\textcopyright} The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Funding: We are grateful to Medtronic Plc and Boston Scientific for their support in funding this study, in the form of unrestricted educational grants.",

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doi = "10.1093/europace/euab167",

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T1 - Greyzone myocardial fibrosis and ventricular arrhythmias in patients with a left ventricular ejection fraction >35%

AU - Zegard, Abbasin

AU - Okafor, Osita

AU - de Bono, Joseph

AU - Kalla, Manish

AU - Lencioni, Mauro

AU - Marshall, Howard

AU - Hudsmith, Lucy

AU - Qiu, Tian

AU - Steeds, Richard

AU - Stegemann, Berthold

AU - Leyva-Leon, Francisco

N1 - © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Funding: We are grateful to Medtronic Plc and Boston Scientific for their support in funding this study, in the form of unrestricted educational grants.

PY - 2022/1/4

Y1 - 2022/1/4

N2 - AIMS: To determine whether myocardial fibrosis and greyzone fibrosis (GZF) on cardiovascular magnetic resonance (CMR) is associated with ventricular arrhythmias in patients with coronary artery disease (CAD) and a left ventricular ejection fraction (LVEF) >35%.METHODS AND RESULTS: In this retrospective study of CAD patients, GZF mass using the 3SD method (GZF3SD) and total fibrosis mass using the 2SD method (TF2SD) on CMR were assessed in relation to the primary, combined endpoint of sudden cardiac death, ventricular tachycardia, ventricular fibrillation, or resuscitated cardiac arrest. Among 701 patients [age: 65.8 ± 12.3 years (mean ± SD)], 28 (3.99%) patients met the primary endpoint over 5.91 years (median; interquartile range 4.42-7.64). In competing risks analysis, a GZF3SD mass ≥5.0 g was strongly associated with the primary endpoint [subdistribution hazard ratio (sHR): 17.4 (95% confidence interval, CI 6.64-45.5); area under receiver operator characteristic curve (AUC): 0.85, P < 0.001]. A weaker association was observed for TF2SD mass ≥23 g [sHR 10.4 (95% CI 4.22-25.8); AUC: 0.80, P < 0.001]. The range of sHRs for GZF3SD mass (1-527) was wider than for TF2SD mass (1-37.6).CONCLUSIONS: In CAD patients with an LVEF >35%, GZF3SD mass was strongly associated with the arrhythmic endpoint. These findings hold promise for its use in identifying patients with CAD and an LVEF >35% at risk of arrhythmic events.

AB - AIMS: To determine whether myocardial fibrosis and greyzone fibrosis (GZF) on cardiovascular magnetic resonance (CMR) is associated with ventricular arrhythmias in patients with coronary artery disease (CAD) and a left ventricular ejection fraction (LVEF) >35%.METHODS AND RESULTS: In this retrospective study of CAD patients, GZF mass using the 3SD method (GZF3SD) and total fibrosis mass using the 2SD method (TF2SD) on CMR were assessed in relation to the primary, combined endpoint of sudden cardiac death, ventricular tachycardia, ventricular fibrillation, or resuscitated cardiac arrest. Among 701 patients [age: 65.8 ± 12.3 years (mean ± SD)], 28 (3.99%) patients met the primary endpoint over 5.91 years (median; interquartile range 4.42-7.64). In competing risks analysis, a GZF3SD mass ≥5.0 g was strongly associated with the primary endpoint [subdistribution hazard ratio (sHR): 17.4 (95% confidence interval, CI 6.64-45.5); area under receiver operator characteristic curve (AUC): 0.85, P < 0.001]. A weaker association was observed for TF2SD mass ≥23 g [sHR 10.4 (95% CI 4.22-25.8); AUC: 0.80, P < 0.001]. The range of sHRs for GZF3SD mass (1-527) was wider than for TF2SD mass (1-37.6).CONCLUSIONS: In CAD patients with an LVEF >35%, GZF3SD mass was strongly associated with the arrhythmic endpoint. These findings hold promise for its use in identifying patients with CAD and an LVEF >35% at risk of arrhythmic events.

KW - Cardiovascular magnetic resonance

KW - Coronary artery disease

KW - Greyzone scar

KW - Myocardial fibrosis

KW - Sudden cardiac death

KW - Ventricular fibrillation

KW - Ventricular tachycardia

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DO - 10.1093/europace/euab167

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SN - 1099-5129

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EP - 39

JO - Europace

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Greyzone myocardial fibrosis and ventricular arrhythmias in patients with a left ventricular ejection fraction >35%

Abstract

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Keywords

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