Different Substrates of Non-Sustained Ventricular Tachycardia in Post-infarction Patients With and Without Left Ventricular Dilatation

Di Bella, Gianluca; Passino, Claudio; Aquaro, Giovanni Donato; Rovai, Daniele; Strata, Elisabetta; Arrigo, Francesco; Emdin, Michele; Lombardi, Massimo; Pingitore, Alessandro

doi:10.1016/j.cardfail.2009.09.001

« Previous Next »Journal of Cardiac Failure
Volume 16, Issue 1 , Pages 61-68, January 2010

Different Substrates of Non-Sustained Ventricular Tachycardia in Post-infarction Patients With and Without Left Ventricular Dilatation

Gianluca Di Bella, MD, PhD
- CNR, Institute of Clinical Physiology, G. Monasterio Foundation, Pisa, Italy
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
Claudio Passino, MD
- CNR, Institute of Clinical Physiology, G. Monasterio Foundation, Pisa, Italy
- Scuola Superiore Sant'Anna, Pisa, Italy
Giovanni Donato Aquaro, MD
- CNR, Institute of Clinical Physiology, G. Monasterio Foundation, Pisa, Italy
Daniele Rovai, MD, FESC
- CNR, Institute of Clinical Physiology, G. Monasterio Foundation, Pisa, Italy
Elisabetta Strata, MD
- CNR, Institute of Clinical Physiology, G. Monasterio Foundation, Pisa, Italy
Francesco Arrigo, MD
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
Michele Emdin, MD, PhD
- CNR, Institute of Clinical Physiology, G. Monasterio Foundation, Pisa, Italy
Massimo Lombardi, MD
- CNR, Institute of Clinical Physiology, G. Monasterio Foundation, Pisa, Italy
Alessandro Pingitore, MD, PhD
- CNR, Institute of Clinical Physiology, G. Monasterio Foundation, Pisa, Italy
- Reprint requests: Alessandro Pingitore, MD, PhD, CNR, Clinical Physiology Institute, G. Monasterio Foundation, Via Moruzzi, 1, 56124 Pisa, Italy. Tel: 0039-050-315 2605; Fax: 0039-050-315 2166.

Received 28 November 2008; received in revised form 10 June 2009; accepted 4 September 2009. published online 23 October 2009.

Abstract

Background

We investigated the relationship between nonsustained ventricular tachycardia (NSVT) and left ventricular (LV) dilatation, function, remodeling, and scar tissue extent in patients with previous myocardial infarction (MI).

Methods and Results

Eighty-two patients (ages 64±10 years) with first previous MI were referred for 24-hour electrocardiogram recording and cine and delayed enhancement (DE) cardiac magnetic resonance (CMR). LV volumes, ejection fraction, systolic wall thickening, sphericity index, and core and peri-infarctual areas of scar tissue by CMR were evaluated. LV dilatation was observed in 39 patients. Episodes of NSVT were recorded in 32 patients: 23 with LV dilatation and 9 without. In the entire population, NSVT was related to ejection fraction, LV volumes, LV mass, and sphericity index; end-systolic volume (P=.001) resulted in the only independent predictor at multivariate analysis. In patients without LV dilatation, the occurrence of NSVT was only positively related with percentage of contracting segments with DE (P=.008). Conversely, in patients with LV dilatation, increase in LV mass (P=.020) and end-systolic volume (P=.038) were independent predictors of NSVT.

Conclusions

Necrotic and viable myocardium coexistence within the same wall segments predicted occurrence of NSVT in patients without LV dilatation, whereas LV mass and end-systolic volume were predictors of NSVT in those with LV dilatation.

Key Words: Cardiac magnetic resonance, scar tissue, myocardial infarction