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Myocardial Fibrosis as a Pathway of Prediction of Ventricular Arrhythmias and Sudden Cardiac Death in Patients With Nonischemic Dilated Cardiomyopathy.
Centurión, Osmar Antonio; Alderete, José Fernando; Torales, Judith María; García, Laura Beatriz; Scavenius, Karina Elizabeth; Miño, Luis Marcelo.
Afiliação
  • Centurión OA; From the Division of Cardiovascular Medicine, Clinic Hospital, Asuncion National University (UNA), San Lorenzo, Paraguay.
  • Alderete JF; Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora, Paraguay.
  • Torales JM; From the Division of Cardiovascular Medicine, Clinic Hospital, Asuncion National University (UNA), San Lorenzo, Paraguay.
  • García LB; From the Division of Cardiovascular Medicine, Clinic Hospital, Asuncion National University (UNA), San Lorenzo, Paraguay.
  • Scavenius KE; Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora, Paraguay.
  • Miño LM; From the Division of Cardiovascular Medicine, Clinic Hospital, Asuncion National University (UNA), San Lorenzo, Paraguay.
Crit Pathw Cardiol ; 18(2): 89-97, 2019 06.
Article em En | MEDLINE | ID: mdl-31094736
The mechanism of sudden cardiac death (SCD) in patients with nonischemic dilated cardiomyopathy (NIDCM) is mostly due to sustained ventricular tachycardia and ventricular fibrillation. The clinical guidelines for the therapeutic management of this set of patients are mostly based on left ventricular ejection fraction value which has a low specificity to differentiate the risk of SCD from the risk of mortality associated with heart failure or other comorbidities. Moreover, since SCD can occur in patients with normal or mildly depressed ejection fraction, it is necessary to identify new markers to improve the prognostic stratification of SCD. Several studies that analyzed the ventricular arrhythmia substrate found that myocardial fibrosis plays an important role in the genesis of ventricular arrhythmias in patients with NIDCM. The surrounding zone of the area of fibrosis is a heterogeneous medium, where tissue with different levels of fibrosis coexists, resulting in both viable and nonviable myocardium. This myocardial fibrosis may constitute a substrate for ventricular arrhythmias, where slow and heterogeneous conduction may favor the genesis of reentry mechanism increasing the chance to develop sustained ventricular tachycardia or ventricular fibrillation. Therefore, the evaluation of ventricular fibrosis by late gadolinium enhancement (LGE) cardiac magnetic resonance imaging has been suggested as an indicator for SCD risk stratification. Indeed, LGE in patients with NIDCM is associated with increased risk of all-cause mortality, heart failure hospitalization, and SCD. Detection of myocardial fibrosis as LGE by cardiac magnetic resonance imaging can be considered as a useful pathway of prediction of malignant ventricular arrhythmias since it has excellent prognostic characteristics and may help guide risk stratification and management in patients with NIDCM.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fibrilação Ventricular / Morte Súbita Cardíaca / Medição de Risco / Imagem Cinética por Ressonância Magnética / Miocárdio Tipo de estudo: Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Crit Pathw Cardiol Assunto da revista: CARDIOLOGIA Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Paraguai País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fibrilação Ventricular / Morte Súbita Cardíaca / Medição de Risco / Imagem Cinética por Ressonância Magnética / Miocárdio Tipo de estudo: Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Crit Pathw Cardiol Assunto da revista: CARDIOLOGIA Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Paraguai País de publicação: Estados Unidos