Diffuse interstitial fibrosis assessed by cardiac magnetic resonance is associated with dispersion of ventricular repolarization in patients with hypertrophic cardiomyopathy

David Hurtado-de-Mendoza, Celia Corona Villalobos, Iraklis Pozios, Jorge Gonzales, Yalda Soleimanifard, Sanjay Sivalokanathan, Diego Montoya-Cerrillo, Styliani Vakrou, Ihab R Kamel, Wilfredo Mormontoy-Laurel, Ketty Dolores-Cerna, Jacsel Suarez, Sergio Perez-Melo, David A. Bluemke, Theodore P. Abraham, Stefan Zimmerman, M. Roselle Abraham

Research output: Contribution to journalArticle

Abstract

Background: Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, disarray, fibrosis, and increased risk for ventricular arrhythmias. Increased QT dispersion has been reported in patients with HCM, but the underlying mechanisms have not been completely elucidated. In this study, we examined the relationship between diffuse interstitial fibrosis, replacement fibrosis, QTc dispersion and ventricular arrhythmias in patients with HCM. We hypothesized that fibrosis would slow impulse propagation and increase dispersion of ventricular repolarization, resulting in increased QTc dispersion on surface electrocardiogram (ECG) and ventricular arrhythmias. Methods: ECG and cardiac magnetic resonance (CMR) image analyses were performed retrospectively in 112 patients with a clinical diagnosis of HCM. Replacement fibrosis was assessed by measuring late gadolinium (Gd) enhancement (LGE), using a semi-automated threshold technique. Diffuse interstitial fibrosis was assessed by measuring T1 relaxation times after Gd administration, using the Look-Locker sequence. QTc dispersion was measured digitally in the septal/anterior (V1-V4), inferior (II, III, and aVF), and lateral (I, aVL, V5, and V6) lead groups on surface ECG. Results: All patients had evidence of asymmetric septal hypertrophy. LGE was evident in 70 (63%) patients; the median T1 relaxation time was 411±38. ms. An inverse correlation was observed between T1 relaxation time and QTc dispersion in leads V1-V4 (p<0.001). Patients with HCM who developed sustained ventricular tachycardia had slightly higher probability of increased QTc dispersion in leads V1-V4 (odds ratio, 1.011 [1.004-1.0178, . p=0.003). We found no correlation between presence and percentage of LGE and QTc dispersion. Conclusion: Diffuse interstitial fibrosis is associated with increased dispersion of ventricular repolarization in leads, reflecting electrical activity in the hypertrophied septum. Interstitial fibrosis combined with ion channel/gap junction remodeling in the septum could lead to inhomogeneity of ventricular refractoriness, resulting in increased QTc dispersion in leads V1-V4.

Original languageEnglish (US)
JournalJournal of Arrhythmia
DOIs
StateAccepted/In press - Mar 11 2016

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Hypertrophic Cardiomyopathy
Fibrosis
Magnetic Resonance Spectroscopy
Cardiac Arrhythmias
Electrocardiography
Gadolinium
Hypertrophy
Gap Junctions
Ventricular Tachycardia
Ion Channels
Muscle Cells
Odds Ratio

Keywords

  • Corrected QT dispersion
  • Hypertrophic cardiomyopathy
  • Late gadolinium enhancement
  • T1 relaxation time

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Diffuse interstitial fibrosis assessed by cardiac magnetic resonance is associated with dispersion of ventricular repolarization in patients with hypertrophic cardiomyopathy. / Hurtado-de-Mendoza, David; Corona Villalobos, Celia; Pozios, Iraklis; Gonzales, Jorge; Soleimanifard, Yalda; Sivalokanathan, Sanjay; Montoya-Cerrillo, Diego; Vakrou, Styliani; Kamel, Ihab R; Mormontoy-Laurel, Wilfredo; Dolores-Cerna, Ketty; Suarez, Jacsel; Perez-Melo, Sergio; Bluemke, David A.; Abraham, Theodore P.; Zimmerman, Stefan; Abraham, M. Roselle.

In: Journal of Arrhythmia, 11.03.2016.

Research output: Contribution to journalArticle

Hurtado-de-Mendoza, D, Corona Villalobos, C, Pozios, I, Gonzales, J, Soleimanifard, Y, Sivalokanathan, S, Montoya-Cerrillo, D, Vakrou, S, Kamel, IR, Mormontoy-Laurel, W, Dolores-Cerna, K, Suarez, J, Perez-Melo, S, Bluemke, DA, Abraham, TP, Zimmerman, S & Abraham, MR 2016, 'Diffuse interstitial fibrosis assessed by cardiac magnetic resonance is associated with dispersion of ventricular repolarization in patients with hypertrophic cardiomyopathy', Journal of Arrhythmia. https://doi.org/10.1016/j.joa.2016.10.005
Hurtado-de-Mendoza, David ; Corona Villalobos, Celia ; Pozios, Iraklis ; Gonzales, Jorge ; Soleimanifard, Yalda ; Sivalokanathan, Sanjay ; Montoya-Cerrillo, Diego ; Vakrou, Styliani ; Kamel, Ihab R ; Mormontoy-Laurel, Wilfredo ; Dolores-Cerna, Ketty ; Suarez, Jacsel ; Perez-Melo, Sergio ; Bluemke, David A. ; Abraham, Theodore P. ; Zimmerman, Stefan ; Abraham, M. Roselle. / Diffuse interstitial fibrosis assessed by cardiac magnetic resonance is associated with dispersion of ventricular repolarization in patients with hypertrophic cardiomyopathy. In: Journal of Arrhythmia. 2016.
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abstract = "Background: Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, disarray, fibrosis, and increased risk for ventricular arrhythmias. Increased QT dispersion has been reported in patients with HCM, but the underlying mechanisms have not been completely elucidated. In this study, we examined the relationship between diffuse interstitial fibrosis, replacement fibrosis, QTc dispersion and ventricular arrhythmias in patients with HCM. We hypothesized that fibrosis would slow impulse propagation and increase dispersion of ventricular repolarization, resulting in increased QTc dispersion on surface electrocardiogram (ECG) and ventricular arrhythmias. Methods: ECG and cardiac magnetic resonance (CMR) image analyses were performed retrospectively in 112 patients with a clinical diagnosis of HCM. Replacement fibrosis was assessed by measuring late gadolinium (Gd) enhancement (LGE), using a semi-automated threshold technique. Diffuse interstitial fibrosis was assessed by measuring T1 relaxation times after Gd administration, using the Look-Locker sequence. QTc dispersion was measured digitally in the septal/anterior (V1-V4), inferior (II, III, and aVF), and lateral (I, aVL, V5, and V6) lead groups on surface ECG. Results: All patients had evidence of asymmetric septal hypertrophy. LGE was evident in 70 (63{\%}) patients; the median T1 relaxation time was 411±38. ms. An inverse correlation was observed between T1 relaxation time and QTc dispersion in leads V1-V4 (p<0.001). Patients with HCM who developed sustained ventricular tachycardia had slightly higher probability of increased QTc dispersion in leads V1-V4 (odds ratio, 1.011 [1.004-1.0178, . p=0.003). We found no correlation between presence and percentage of LGE and QTc dispersion. Conclusion: Diffuse interstitial fibrosis is associated with increased dispersion of ventricular repolarization in leads, reflecting electrical activity in the hypertrophied septum. Interstitial fibrosis combined with ion channel/gap junction remodeling in the septum could lead to inhomogeneity of ventricular refractoriness, resulting in increased QTc dispersion in leads V1-V4.",
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author = "David Hurtado-de-Mendoza and {Corona Villalobos}, Celia and Iraklis Pozios and Jorge Gonzales and Yalda Soleimanifard and Sanjay Sivalokanathan and Diego Montoya-Cerrillo and Styliani Vakrou and Kamel, {Ihab R} and Wilfredo Mormontoy-Laurel and Ketty Dolores-Cerna and Jacsel Suarez and Sergio Perez-Melo and Bluemke, {David A.} and Abraham, {Theodore P.} and Stefan Zimmerman and Abraham, {M. Roselle}",
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T1 - Diffuse interstitial fibrosis assessed by cardiac magnetic resonance is associated with dispersion of ventricular repolarization in patients with hypertrophic cardiomyopathy

AU - Hurtado-de-Mendoza, David

AU - Corona Villalobos, Celia

AU - Pozios, Iraklis

AU - Gonzales, Jorge

AU - Soleimanifard, Yalda

AU - Sivalokanathan, Sanjay

AU - Montoya-Cerrillo, Diego

AU - Vakrou, Styliani

AU - Kamel, Ihab R

AU - Mormontoy-Laurel, Wilfredo

AU - Dolores-Cerna, Ketty

AU - Suarez, Jacsel

AU - Perez-Melo, Sergio

AU - Bluemke, David A.

AU - Abraham, Theodore P.

AU - Zimmerman, Stefan

AU - Abraham, M. Roselle

PY - 2016/3/11

Y1 - 2016/3/11

N2 - Background: Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, disarray, fibrosis, and increased risk for ventricular arrhythmias. Increased QT dispersion has been reported in patients with HCM, but the underlying mechanisms have not been completely elucidated. In this study, we examined the relationship between diffuse interstitial fibrosis, replacement fibrosis, QTc dispersion and ventricular arrhythmias in patients with HCM. We hypothesized that fibrosis would slow impulse propagation and increase dispersion of ventricular repolarization, resulting in increased QTc dispersion on surface electrocardiogram (ECG) and ventricular arrhythmias. Methods: ECG and cardiac magnetic resonance (CMR) image analyses were performed retrospectively in 112 patients with a clinical diagnosis of HCM. Replacement fibrosis was assessed by measuring late gadolinium (Gd) enhancement (LGE), using a semi-automated threshold technique. Diffuse interstitial fibrosis was assessed by measuring T1 relaxation times after Gd administration, using the Look-Locker sequence. QTc dispersion was measured digitally in the septal/anterior (V1-V4), inferior (II, III, and aVF), and lateral (I, aVL, V5, and V6) lead groups on surface ECG. Results: All patients had evidence of asymmetric septal hypertrophy. LGE was evident in 70 (63%) patients; the median T1 relaxation time was 411±38. ms. An inverse correlation was observed between T1 relaxation time and QTc dispersion in leads V1-V4 (p<0.001). Patients with HCM who developed sustained ventricular tachycardia had slightly higher probability of increased QTc dispersion in leads V1-V4 (odds ratio, 1.011 [1.004-1.0178, . p=0.003). We found no correlation between presence and percentage of LGE and QTc dispersion. Conclusion: Diffuse interstitial fibrosis is associated with increased dispersion of ventricular repolarization in leads, reflecting electrical activity in the hypertrophied septum. Interstitial fibrosis combined with ion channel/gap junction remodeling in the septum could lead to inhomogeneity of ventricular refractoriness, resulting in increased QTc dispersion in leads V1-V4.

AB - Background: Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, disarray, fibrosis, and increased risk for ventricular arrhythmias. Increased QT dispersion has been reported in patients with HCM, but the underlying mechanisms have not been completely elucidated. In this study, we examined the relationship between diffuse interstitial fibrosis, replacement fibrosis, QTc dispersion and ventricular arrhythmias in patients with HCM. We hypothesized that fibrosis would slow impulse propagation and increase dispersion of ventricular repolarization, resulting in increased QTc dispersion on surface electrocardiogram (ECG) and ventricular arrhythmias. Methods: ECG and cardiac magnetic resonance (CMR) image analyses were performed retrospectively in 112 patients with a clinical diagnosis of HCM. Replacement fibrosis was assessed by measuring late gadolinium (Gd) enhancement (LGE), using a semi-automated threshold technique. Diffuse interstitial fibrosis was assessed by measuring T1 relaxation times after Gd administration, using the Look-Locker sequence. QTc dispersion was measured digitally in the septal/anterior (V1-V4), inferior (II, III, and aVF), and lateral (I, aVL, V5, and V6) lead groups on surface ECG. Results: All patients had evidence of asymmetric septal hypertrophy. LGE was evident in 70 (63%) patients; the median T1 relaxation time was 411±38. ms. An inverse correlation was observed between T1 relaxation time and QTc dispersion in leads V1-V4 (p<0.001). Patients with HCM who developed sustained ventricular tachycardia had slightly higher probability of increased QTc dispersion in leads V1-V4 (odds ratio, 1.011 [1.004-1.0178, . p=0.003). We found no correlation between presence and percentage of LGE and QTc dispersion. Conclusion: Diffuse interstitial fibrosis is associated with increased dispersion of ventricular repolarization in leads, reflecting electrical activity in the hypertrophied septum. Interstitial fibrosis combined with ion channel/gap junction remodeling in the septum could lead to inhomogeneity of ventricular refractoriness, resulting in increased QTc dispersion in leads V1-V4.

KW - Corrected QT dispersion

KW - Hypertrophic cardiomyopathy

KW - Late gadolinium enhancement

KW - T1 relaxation time

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