Arrhythmias & electrophysiologyCohort study
Arrhythmic risk stratification in patients with left ventricular ring-like scar
- Retrospective cohort study
- multicentre
- 6 referral centres
Authors' conclusion
In this study, the LV ring-like scar phenotype was associated with a high rate of malignant arrhythmias in presence of anterior Q waves, QRS prolongation, and increased LVEDVi. A normal ECG identified a lower risk sub-group.
Study context
- Population
- Patients with left ventricular (LV) ring-like scar on cardiac magnetic resonance (CMR) (≥3 contiguous segments with sub-epicardial/midwall late gadolinium enhancement (LGE) in the same slice) plus a pathogenic/likely pathogenic genetic variant, family history of cardiomyopathy, or arrhythmogenic cardiomyopathy diagnosismedian age 39, 42% females
- Participants
- 115 patients
- Exposure
- Normal electrocardiogram (ECG) vs abnormal ECG and no LAEs predictive variables vs abnormal ECG and ≥1 LAEs predictive variables
- Outcome
- Life-threatening arrhythmic events (LAEs): composite of sudden cardiac death (SCD), aborted SCD and sustained VT
Main finding
As reported in the abstract
Survival free from LAEs and independent predictors of LAEs
Normal ECG
100
% survival
Abnormal ECG, no LAE predictors
65%
survival
Abnormal ECG, ≥1 LAE predictor
49%
survival
Estimate (95% CI)P value
Anterior Q waves vs Normal ECG
HR 1.030(1.014–1.046)
P < 0.001QRS width vs Normal ECG
HR 4.642(1.296–16.628)
P = 0.018LVEDVi
HR 1.011 per mL/m² increase(1.001–1.021)
P = 0.040- Overall survival free from LAEs during follow-up
- 60% (3.8 events/100 patients/year)
- Survival free from LAEs at median follow-up 4.6 years (IQR 1.7-8.4)
- 84%
- Harrell's C-index
- 0.796
Observational data: associations, not effects.
Original publication
Arrhythmic risk stratification in patients with left ventricular ring-like scar. Eur J Prev Cardiol. Published 1 November 2024. doi:10.1093/eurjpc/zwae353
Summarised from the published abstract; every number is checked against it