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Scar size and characteristics assessed by CMR predict ventricular arrhythmias in ischaemic cardiomyopathy: comparison of previously validated models
  1. Stefan de Haan,
  2. Thomas A Meijers,
  3. Paul Knaapen,
  4. Aernout M Beek,
  5. Albert C van Rossum,
  6. Cornelis P Allaart
  1. Department of Cardiology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Stefan de Haan, VU University Medical Center, Department of Cardiology, De Boelelaan 1118, Amsterdam 1081 HV, The Netherlands; s.dehaan{at}


Objective Sudden cardiac death is a major cause of mortality in patients with ischaemic cardiomyopathy. Risk stratification remains challenging. Currently, there is growing interest in scar characteristic assessment as a predictor of sudden cardiac death using cardiac magnetic resonance imaging (CMR). Standard analysis methods are lacking. The present study evaluated previously validated methods of scar assessment by CMR with late gadolinium enhancement (LGE) in their ability to predict ventricular tachyarrhythmias.

Methods Patients with ischaemic cardiomyopathy who received an implantable cardioverter defibrillator for primary prevention and in whom a LGE–CMR was performed, were included. Scar core size, peri-infarct zone and total scar size, which is defined as the sum of the core size and peri-infarct zone, were assessed using three previously validated models, and their ability to predict ventricular tachyarrhythmias was evaluated.

Results Fifty-five patients were included (mean age 64.6±10.8 years, 43 men). During a median follow-up of 2.0 years (IQR 1.0–3.0 years) 26% of patients reached the endpoint of ventricular tachyarrhythmia. All scar characteristics (ie, total scar size, scar core size and peri-infarct zone) of the three methods were predictors of the endpoint (p<0.01). Total scar size was comparable, whereas scar core size and peri-infarct zone varied significantly between the tested models. Receiver operating characteristic curves of the different scar characteristics showed comparable areas under the curve varying from 0.721 to 0.812.

Conclusions LGE–CMR-derived scar tissue characteristics are of predictive value for the occurrence of ventricular tachyarrhythmias in patients with ischaemic cardiomyopathy. Additional estimation of scar core size and/or peri-infarct zone does not appear to increase the diagnostic accuracy over total scar size alone.

  • Cardiac imaging
  • cardiac magnetic resonance imaging
  • cardiomyopathy dilated
  • cardiomyopathy hypertrophic
  • clinical cardiology
  • clinical coronary heart disease
  • coronary artery disease (CAD)
  • EBM
  • heart failure
  • hypertrophic cardiomyopathy
  • implantable cardioverter defibrillator
  • late gadolinium enhancement
  • MRI
  • myocardial ischaemia and infarction (IHD)
  • myocardial perfusion
  • nuclear cardiology
  • pacing
  • stable angina
  • sudden cardiac death
  • ventricular fibrillation
  • ventricular tachycardia

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  • Funding This research was performed within the framework of CTMM, the Center for Translational Molecular Medicine (, project COHFAR (grant 01C-203), and supported by The Netherlands Heart Foundation.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.