Cardiovascular magnetic resonance determinants of ventricular arrhythmic events after myocardial infarction Beatriz Ja ´uregui 1,2 , David Soto-Iglesias 1,2 , Diego Penela 1,2 , Juan Acosta 3 , Juan Ferna ´ndez-Armenta 4 , Markus Linhart 5 , Augusto Ordo ´ ~ nez 1 , Rodolfo San Antonio 1 , Cheryl Tere ´s 1 , Alfredo Chauca 1 , Jose ´ M. Carre~ no 1 , Claudia Scherer 1 , Giulio Falasconi 1 , Susana Prat-Gonza ´lez 2 , Rosario J. Perea 2 , Lluı ´s Mont 2 , Xavier Bosch 2 , Jose ´ T. Ortiz-Pe ´ rez 2 , and Antonio Berruezo 1,2 * 1 Arrhythmia Department, Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain; 2 Arrhythmia Department, Hospital Clı ´nic, University of Barcelona, C/ Villarroel 170, 08024 Barcelona, Spain; 3 Arrhythmia Department, Virgen del Rocı ´o University Hospital, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain; 4 Arrhythmia Department, Puerta del Mar University Hospital, Avda. Ana de Viya 21, 11009 Ca ´diz, Spain; and 5 Arrhythmia Department, Josep Trueta University Hospital, Avda. de Franc¸a s/n, 17007 Girona, Spain Aims To non-invasively characterize, by means of late gadolinium enhancement cardiac magnetic resonance (LGE-CMR), scar differences, and potential variables associated with ventricular tachycardia (VT) occurrence in chronic post- myocardial infarction (MI) patients. ................................................................................................................................................................................................... Methods and results A case–control study was designed through retrospective LGE-CMR data analysis of chronic post-MI patients (i) consecutively referred for VT substrate ablation after a first VT episode (n = 66) and (ii) from a control group (n = 84) with no arrhythmia evidence. The myocardium was characterized differentiating core, border zone (BZ), and BZ channels (BZCs) using the ADAS 3D post-processing imaging platform. Clinical and scar characteristics, in- cluding a novel parameter, the BZC mass, were compared between both groups. One hundred and fifty post-MI patients were included. Four multivariable Cox proportional hazards regression models were created for total scar mass, BZ mass, core mass, and BZC mass, adjusting them by age, sex, and left ventricular ejection fraction (LVEF). A cut-off of 5.15 g of BZC mass identified the cases with 92.4% sensitivity and 86.9% specificity [area under the ROC curve (AUC) 0.93 (0.89–0.97); P < 0.001], with a significant increase in the AUC compared to other scar parameters (P < 0.001 for all pairwise comparisons). Adding BZC mass to LVEF allowed to reclassify 33.3% of the cases and 39.3% of the controls [net reclassification improvement = 0.73 (0.71–0.74)]. ................................................................................................................................................................................................... Conclusions The mass of BZC is the strongest independent variable associated with the occurrence of sustained monomorphic ventricular tachycardia in post-MI patients after adjustment for age, sex, and LVEF. Border zone channel mass mea- surement could permit a more accurate VT risk stratification than LVEF in chronic post-MI patients.                                                                                                                                                                                                                     *Corresponding author. Tel: þ34 932 90 62 00; fax: þ34 932 11 26 90. E-mail address: antonio.berruezo@quironsalud.es Published on behalf of the European Society of Cardiology. All rights reserved. V C The Author(s) 2021. For permissions, please email: journals.permissions@oup.com. CLINICAL RESEARCH https://doi.org/10.1093/europace/euab275 Europace (2022) 24, 938–947 Received 14 May 2021; editorial decision 22 October 2021; accepted after revision 26 October 2021; online publish-ahead-of-print 29 November 2021 Ventricular tachycardia: mapping and ablation Downloaded from https://academic.oup.com/europace/article/24/6/938/6445255 by guest on 16 July 2022