Journal of Electrocardiology
Volume 42, Issue 2 , Pages 138.e1-138.e8 , March 2009

Imaging myocardial scar and arrhythmic risk prediction—a role for the electrocardiogram?

  • David G. Strauss, BA

      Affiliations

    • Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
    • Department of Clinical Physiology, Lund University Hospital, Lund, Sweden
    • School of Medicine, Duke University, Durham, NC, USA
    • ,
  • Katherine C. Wu, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 410 502 7283; fax: +1 410 502 0231.

Received 6 November 2008

References 

  1. Goldenberg I, Vyas AK, Hall WJ, et al. Risk stratification for primary implantation of a cardioverter-defibrillator in patients with ischemic left ventricular dysfunction. J Am Coll Cardiol. 2008;51:288
  2. de Vreede-Swagemakers JJ, Gorgels AP, Dubois-Arbouw WI, et al. Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and survival. J Am Coll Cardiol. 1997;30:1500
  3. Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877
  4. Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:225
  5. Zipes DP, Wellens HJ. Sudden cardiac death. Circulation. 1998;98:2334
  6. Carlsson M, Arheden H, Higgins CB, Saeed M. Magnetic resonance imaging as a potential gold standard for infarct quantification. J Electrocardiol. 2008;41:614
  7. Wu KC, Lima JA. Noninvasive imaging of myocardial viability: current techniques and future developments. Circ Res. 2003;93:1146
  8. Schmidt A, Wu KC. MRI assessment of myocardial viability. Semin Ultrasound CT MR. 2006;27:11
  9. Yan AT, Shayne AJ, Brown KA, et al. Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality. Circulation. 2006;114:32
  10. Schmidt A, Azevedo CF, Cheng A, et al. Infarct tissue heterogeneity by magnetic resonance imaging identifies enhanced cardiac arrhythmia susceptibility in patients with left ventricular dysfunction. Circulation. 2007;115:2006
  11. Bello D, Fieno DS, Kim RJ, et al. Infarct morphology identifies patients with substrate for sustained ventricular tachycardia. J Am Coll Cardiol. 2005;45:1104
  12. Strauss DG, Selvester RH. The QRS complex—a biomarker that “images” the heart: QRS scores to quantify myocardial scar in the presence of normal and abnormal ventricular conduction. J Electrocardiol. 2009;42:86
  13. Strauss DG, Selvester RH, Lima JAC, et al. ECG quantification of myocardial scar in cardiomyopathy patients with or without conduction defects: correlation with cardiac magnetic resonance and arrhythmogenesis. Circ Arrhythmia Electrophysiol. 2008;1:327
  14. Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006;113:2495
  15. Mahenthiran J, Khan BR, Sawada SG, Das MK. Fragmented QRS complexes not typical of a bundle branch block: a marker of greater myocardial perfusion tomography abnormalities in coronary artery disease. J Nucl Cardiol. 2007;14:347
  16. Das MK, Suradi H, Maskoun W, et al. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythmia Electrophysiol. 2008;1:258
  17. Selvester RH, Kalaba R, Collier CR, Bellman R, Kagiwada H. A digital computer model of the vectorcardiogram with distance and boundary effects: simulated myocardial infarction. Am Heart J. 1967;74:792
  18. Selvester RH, Rubin HB, Hamlin JA, Pote WW. New quantitative vectorcardiographic criteria for the detection of unsuspected myocardial infarction in diabetics. Am Heart J. 1968;75:335
  19. Reddy CV, Cheriparambill K, Saul B, et al. Fragmented left-sided QRS in absence of bundle branch block: sign of left ventricular aneurysm. Ann Noninvasive Electrocardiol. 2006;11:132
  20. Das MK, Saha C, El Masry H, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm. 2007;4:1385
  21. Macedo R, Schmidt A, Rochitte CE, Lima JA, Bluemke DA. MRI to assess arrhythmia and cardiomyopathies. J Magn Reson Imaging. 2006;24:1197
  22. Mahrholdt H, Wagner A, Judd RM, Sechtem U, Kim RJ. Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies. Eur Heart J. 2005;26:1461
  23. O'Hanlon R, Prasad SK, Pennell DJ. Evaluation of nonischemic cardiomyopathies using cardiovascular magnetic resonance. J Nucl Cardiol. 2008;15:400
  24. Mann DL, Bristow MR. Mechanisms and models in heart failure: the biomechanical model and beyond. Circulation. 2005;111:2837
  25. Nazarian S, Bluemke DA, Lardo AC, et al. Magnetic resonance assessment of the substrate for inducible ventricular tachycardia in nonischemic cardiomyopathy. Circulation. 2005;112:2821
  26. McCrohon JA, Moon JC, Prasad SK, et al. Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation. 2003;108:54
  27. Assomull RG, Prasad SK, Lyne J, et al. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol. 2006;48:1977
  28. Wu KC, Weiss RG, Thiemann DR, et al. Late gadolinium enhancement by cardiovascular magnetic resonance heralds an adverse prognosis in nonischemic cardiomyopathy. J Am Coll Cardiol. 2008;51:2414
  29. Selvester RH, Wagner GS, Ideker RE. Myocardial Infarction. In:  Macfarlane PW,  Lawrie TDV editor. Comprehensive electrocardiology: theory and practice in health and disease. New York: Pergammon Press; 1989;p. 565
  30. Bahl OP, Massie E. Electrocardiographic and vectorcardiographic patterns in cardiomyopathy. Cardiovasc Clin. 1972;4:95
  31. Banta HD, Estes EH. Electrocardiographic and vectorcardiographic findings in patients with idiopathic myocardial hypertrophy. Am J Cardiol. 1964;14:218
  32. Stapleton JF, Segal JP, Harvey WP. The electrocardiogram of myocardiopathy. Prog Cardiovasc Dis. 1970;13:217
  33. Maron BJ, Spirito P. Implantable defibrillators and prevention of sudden death in hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol. 2008;19:1118
  34. Shirani J, Pick R, Roberts WC, Maron BJ. Morphology and significance of the left ventricular collagen network in young patients with hypertrophic cardiomyopathy and sudden cardiac death. J Am Coll Cardiol. 2000;35:36
  35. Moon JC, McKenna WJ, McCrohon JA, Elliott PM, Smith GC, Pennell DJ. Toward clinical risk assessment in hypertrophic cardiomyopathy with gadolinium cardiovascular magnetic resonance. J Am Coll Cardiol. 2003;41:1561
  36. Maron MS, Finley JJ, Bos JM, et al. Prevalence, clinical significance, and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy. Circulation. 2008;118:1541
  37. Maron BJ, Maron MS, Lesser JR, et al. Sudden cardiac arrest in hypertrophic cardiomyopathy in the absence of conventional criteria for high risk status. Am J Cardiol. 2008;101:544
  38. Teraoka K, Hirano M, Ookubo H, et al. Delayed contrast enhancement of MRI in hypertrophic cardiomyopathy. Magn Reson Imaging. 2004;22:155
  39. Adabag AS, Maron BJ, Appelbaum E, et al. Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance. J Am Coll Cardiol. 2008;51:1369
  40. Papavassiliu T, Fluchter S, Haghi D, et al. Extent of myocardial hyperenhancement on late gadolinium-enhanced cardiovascular magnetic resonance correlates with q waves in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson. 2007;9:595
  41. Moon JC, Sachdev B, Elkington AG, et al. Gadolinium enhanced cardiovascular magnetic resonance in Anderson-Fabry disease. Evidence for a disease specific abnormality of the myocardial interstitium. Eur Heart J. 2003;24:2151
  42. Funabashi N, Toyozaki T, Matsumoto Y, et al. Images in cardiovascular medicine. Myocardial fibrosis in Fabry disease demonstrated by multislice computed tomography: comparison with biopsy findings. Circulation. 2003;107:2519
  43. Linhart A, Lubanda JC, Palecek T, et al. Cardiac manifestations in Fabry disease. J Inherit Metab Dis. 2001;24(Suppl 2):75;[discussion 65]
  44. Hughes DA, Elliott PM, Shah J, et al. Effects of enzyme replacement therapy on the cardiomyopathy of Anderson-Fabry disease: a randomised, double-blind, placebo-controlled clinical trial of agalsidase alfa. Heart. 2008;94:153
  45. Friedrich MG, Strohm O, Schulz-Menger J, Marciniak H, Luft FC, Dietz R. Contrast media-enhanced magnetic resonance imaging visualizes myocardial changes in the course of viral myocarditis. Circulation. 1998;97:1802
  46. Mahrholdt H, Goedecke C, Wagner A, et al. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation. 2004;109:1250
  47. Mahrholdt H, Wagner A, Deluigi CC, et al. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation. 2006;114:1581
  48. Myers GB. Other QRS-T patterns that may be mistaken for myocardial infarction: IV. Alterations in blood potassium; myocardial ischemia; subepicardial myocarditis; distortion associated with arrhythmias. Circulation. 1950;2:75
  49. Rochitte CE, Oliveira PF, Andrade JM, et al. Myocardial delayed enhancement by magnetic resonance imaging in patients with Chagas' disease: a marker of disease severity. J Am Coll Cardiol. 2005;46:1553
  50. Pinto Lima FX, Spiritus O, Tranchesi J. Arrhythmias and vector electrocardiographic analysis of complete bundle branch block in Chagas' disease; a study of 103 autopsied cases. Am Heart J. 1958;56:501
  51. Elizari MV, Acunzo RS, Ferreiro M. Hemiblocks revisited. Circulation. 2007;115:1154
  52. Shammas RL, Movahed A. Sarcoidosis of the heart. Clin Cardiol. 1993;16:462
  53. Silverman KJ, Hutchins GM, Bulkley BH. Cardiac sarcoid: a clinicopathologic study of 84 unselected patients with systemic sarcoidosis. Circulation. 1978;58:1204
  54. Smedema JP, Snoep G, van Kroonenburgh MP, et al. Evaluation of the accuracy of gadolinium-enhanced cardiovascular magnetic resonance in the diagnosis of cardiac sarcoidosis. J Am Coll Cardiol. 2005;45:1683
  55. Schulz-Menger J, Wassmuth R, Abdel-Aty H, et al. Patterns of myocardial inflammation and scarring in sarcoidosis as assessed by cardiovascular magnetic resonance. Heart. 2006;92:399
  56. Mehta D, Lubitz SA, Frankel Z, et al. Cardiac involvement in patients with sarcoidosis: diagnostic and prognostic value of outpatient testing. Chest. 2008;133:1426
  57. Pollack ML. ECG manifestations of selected extracardiac diseases. Emerg Med Clin North Am 2006;24:133-43, vii.

☆ Financial support: DGS is supported by the Sarnoff Cardiovascular Research Foundation, (Great Falls, VA). KCW is supported by the Donald W. Reynolds Cardiovascular Research Center at Johns Hopkins University (Baltimore, MD).

PII: S0022-0736(08)00498-6

doi: 10.1016/j.jelectrocard.2008.12.010

Journal of Electrocardiology
Volume 42, Issue 2 , Pages 138.e1-138.e8 , March 2009

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