Author + information
- Received June 12, 2018
- Revision received December 12, 2018
- Accepted December 12, 2018
- Published online February 27, 2019.
- Alexander F.A. Androulakis, MDa,
- Katja Zeppenfeld, MD, PhDa,∗ (, )
- Elisabeth H.M. Paiman, MDb,
- Sebastiaan R.D. Piers, MD, PhDa,
- Adrianus P. Wijnmaalen, MD, PhDa,
- Hans-Marc J. Siebelink, MD, PhDa,
- Marek Sramko, MD, PhDa,
- Hildo J. Lamb, MD, PhDb,
- Rob J. van der Geest, PhDc,
- Marta de Riva, MDa and
- Qian Tao, PhDc,∗ ()
- aDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- bDepartment of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- cDivision of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- ↵∗Address for correspondence:
Dr. Katja Zeppenfeld, and Dr. Q. Tao, Leiden University Medical Center, Department of Cardiology, Department of Radiology (C-03-Q), P.O. Box 9600, 2300 RC Leiden, the Netherlands.
Objectives This study proposed entropy as a new late gadolinium enhanced cardiac magnetic resonance–derived parameter to evaluate tissue inhomogeneity, independent of signal intensity thresholds. This study hypothesized that entropy within the scar is associated with ventricular arrhythmias (VAs), whereas entropy of the entire left ventricular (LV) myocardium is associated with mortality.
Background In patients after myocardial infarction, the heterogeneity of fibrosis determines the substrate for VA. Fibrosis in remote areas has been associated with heart failure and mortality. Late gadolinium-enhanced cardiac magnetic resonance has been used to delineate fibrosis, but available methods depend on signal intensity thresholds and results have been inconsistent.
Methods Consecutive post–myocardial infarction patients undergoing late gadolinium enhanced cardiac magnetic resonance prior to implantable cardioverter-defibrillator implantation were included. From cardiac magnetic resonance imaging, total scar size, scar gray zone, scar transmurality, and tissue entropy were derived. Patients were followed for appropriate implantable cardioverter-defibrillator therapy and mortality.
Results A total of 154 patients (64 ± 10 years, 84% male, LV ejection fraction 29 ± 10%, 47% acute revascularization) were included. During a median follow-up of 56 (interquartile range: 40, 73) months, appropriate implantable cardioverter-defibrillator therapy occurred in 46 patients (30%), and 41 patients (27%) died. From multivariable analysis, higher entropy of the scar (hazard ratio [HR]: 1.9; 95% confidence interval [CI]: 1.0 to 3.5; p = 0.042) was independently associated with VA, after adjusting for multivessel disease, acute revascularization, LV ejection fraction, scar gray zone, and transmurality. Entropy of the entire LV was independently associated with mortality (HR: 3.2; 95% CI: 1.1 to 9.9; p = 0.038).
Conclusions High entropy within the scar was associated with VA and may indicate an arrhythmogenic scar. High entropy of the entire LV was associated with mortality and may reflect a fibrosis pattern associated with adverse remodeling.
- cardiac magnetic resonance
- diffuse fibrosis
- late gadolinium enhancement
- magnetic resonance imaging
- sudden death
- ventricular arrhythmia
This study was funded by NOW (Nederlandse Organisatie voor Wetenschappelijk Onderzoek - Dutch organisation for Scientific Research) Domain Applied and Engineering Sciences grant no. 12899. The Department of Cardiology (Leiden University Medical Center) has received unrestricted research grants from Edwards Lifesciences, Medtronic, Biotronik, and Boston Scientific. Dr. Zeppenfeld has received funding from a research grant awarded to the Department of Cardiology (Leiden University Medical Center) from Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 12, 2018.
- Revision received December 12, 2018.
- Accepted December 12, 2018.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.