Abstract：
BACKGROUND: Scar substrate in nonischemic cardiomyopathy (NICM) patients is often difficult to identify. Advances in cardiac imaging, especially using late iodine-enhanced computed tomography (LIE-CT), allow better characterization of scars giving rise to ventricular tachycardia (VT). Currently, there are limited data on clinical correlates of CT-derived scar substrates in NICM. We sought assess the relationship between scar location on LIE-CT and outcomes after radiofrequency catheter ablation (RFCA) in NICM patients with VT.
METHODS: From 2020 to 2022, consecutive patients with NICM undergoing VT RFCA with integration of cardiac CT scar modeling (inHeart, Pessac, France) were included at two US tertiary care centers. The CT protocol included both arterial-enhanced imaging for anatomical modeling and LIE-CT for scar assessment. The distribution of substrate on CT was analyzed in relation to patient outcomes, with primary endpoints being VT recurrence and the need for repeat ablation procedure.
RESULTS: Sixty patients were included (age 64 ± 12 years, 90% men). Over a median follow-up of 120 days (interquartile range [IQR]: 41-365), repeat ablation procedures were required in 32 (53%). VT recurrence occurred in 46 (77%), with a median time to recurrence of 40 days (IQR: 8-65). CT-derived total scar volume positively correlated with intrinsic QRS duration (r = .34, p = 0.008). Septal scar was found on CT in 34 (57%), and lateral scar in 40 (7%). On univariate logistic regression, septal scar was associated with increased odds of repeat ablation (odds ratio [OR]: 2.9 [1.0-8.4]; p = 0.046), while lateral scar was not (OR: 0.9 [0.3-2.7]; p = 0.855). Septal scar better predicted VT recurrence when compared to lateral scar, but neither were statistically significant (septal scar OR: 3.0 [0.9-10.7]; p = 0.078; lateral scar OR: 1.7 [0.5-5.9]; p = 0.391).
CONCLUSIONS: In this tertiary care referral population, patients with NICM undergoing VT catheter ablation with septal LIE-CT have nearly threefold increased risk of need for repeat ablation.
METHODS: From 2020 to 2022, consecutive patients with NICM undergoing VT RFCA with integration of cardiac CT scar modeling (inHeart, Pessac, France) were included at two US tertiary care centers. The CT protocol included both arterial-enhanced imaging for anatomical modeling and LIE-CT for scar assessment. The distribution of substrate on CT was analyzed in relation to patient outcomes, with primary endpoints being VT recurrence and the need for repeat ablation procedure.
RESULTS: Sixty patients were included (age 64 ± 12 years, 90% men). Over a median follow-up of 120 days (interquartile range [IQR]: 41-365), repeat ablation procedures were required in 32 (53%). VT recurrence occurred in 46 (77%), with a median time to recurrence of 40 days (IQR: 8-65). CT-derived total scar volume positively correlated with intrinsic QRS duration (r = .34, p = 0.008). Septal scar was found on CT in 34 (57%), and lateral scar in 40 (7%). On univariate logistic regression, septal scar was associated with increased odds of repeat ablation (odds ratio [OR]: 2.9 [1.0-8.4]; p = 0.046), while lateral scar was not (OR: 0.9 [0.3-2.7]; p = 0.855). Septal scar better predicted VT recurrence when compared to lateral scar, but neither were statistically significant (septal scar OR: 3.0 [0.9-10.7]; p = 0.078; lateral scar OR: 1.7 [0.5-5.9]; p = 0.391).
CONCLUSIONS: In this tertiary care referral population, patients with NICM undergoing VT catheter ablation with septal LIE-CT have nearly threefold increased risk of need for repeat ablation.
摘要：
背景：非缺血性心肌病（NICM）患者的瘢痕底物通常难以识别。心脏成像的进展，尤其是使用晚期碘增强计算机断层扫描（LIE-CT），可以更好地表征引起室性心动过速（VT）的疤痕。目前,NICM中CT源性瘢痕基质的临床相关性数据有限。我们试图评估NICM室性心动过速患者LIE-CT上的瘢痕位置与射频导管消融（RFCA）后结果之间的关系。
方法：从2020年到2022年，连续的NICM患者接受VTRFCA并整合心脏CT瘢痕建模（在Heart，Pessac,法国）被包括在美国的两个三级护理中心。CT方案包括用于解剖建模的动脉增强成像和用于瘢痕评估的LIE-CT。分析了CT上基质的分布与患者预后的关系，主要终点是室性心动过速复发和需要重复消融手术。
结果：纳入60例患者（年龄64±12岁，90%男性）。中位随访120天（四分位数范围[IQR]：41-365），32例(53%)需要重复消融术.室性心动过速复发发生在46例（77%），中位复发时间为40天（IQR：8-65）。CT衍生的总瘢痕体积与固有QRS持续时间呈正相关（r=.34，p=0.008）。34例(57%)CT发现间隔瘢痕,外侧瘢痕40例(7%)。在单变量逻辑回归中，间隔瘢痕与重复消融的几率增加相关(比值比[OR]:2.9[1.0-8.4];p=0.046),而外侧瘢痕则没有（OR：0.9[0.3-2.7]；p=0.855）。与外侧瘢痕相比，间隔瘢痕能更好地预测室性心动过速复发，但两者均无统计学意义(间隔瘢痕OR:3.0[0.9-10.7];p=0.078;外侧瘢痕OR:1.7[0.5-5.9];p=0.391)。
结论：在这一三级护理转诊人群中，接受室性心动过速导管消融术的NICM患者需要再次消融术的风险增加近3倍.
方法：从2020年到2022年，连续的NICM患者接受VTRFCA并整合心脏CT瘢痕建模（在Heart，Pessac,法国）被包括在美国的两个三级护理中心。CT方案包括用于解剖建模的动脉增强成像和用于瘢痕评估的LIE-CT。分析了CT上基质的分布与患者预后的关系，主要终点是室性心动过速复发和需要重复消融手术。
结果：纳入60例患者（年龄64±12岁，90%男性）。中位随访120天（四分位数范围[IQR]：41-365），32例(53%)需要重复消融术.室性心动过速复发发生在46例（77%），中位复发时间为40天（IQR：8-65）。CT衍生的总瘢痕体积与固有QRS持续时间呈正相关（r=.34，p=0.008）。34例(57%)CT发现间隔瘢痕,外侧瘢痕40例(7%)。在单变量逻辑回归中，间隔瘢痕与重复消融的几率增加相关(比值比[OR]:2.9[1.0-8.4];p=0.046),而外侧瘢痕则没有（OR：0.9[0.3-2.7]；p=0.855）。与外侧瘢痕相比，间隔瘢痕能更好地预测室性心动过速复发，但两者均无统计学意义(间隔瘢痕OR:3.0[0.9-10.7];p=0.078;外侧瘢痕OR:1.7[0.5-5.9];p=0.391)。
结论：在这一三级护理转诊人群中，接受室性心动过速导管消融术的NICM患者需要再次消融术的风险增加近3倍.
