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

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

doi:10.1016/j.joa.2016.10.005

Journal of Arrhythmia (Jun 2017)

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

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

Affiliations

David Hurtado-de-Mendoza, MD: Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA
Celia P. Corona-Villalobos, MD: The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, MRI 110B, Baltimore, MD 21287, USA
Iraklis Pozios, MD: Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA
Jorge Gonzales, MD: Cayetano Heredia University School of Medicine, 430 Honorio Delgado Ave, Lima, LIMA 31, Peru
Yalda Soleimanifard, MD: Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA
Sanjay Sivalokanathan, MD: Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA
Diego Montoya-Cerrillo, MD: Cayetano Heredia University School of Medicine, 430 Honorio Delgado Ave, Lima, LIMA 31, Peru
Styliani Vakrou, MD: Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA
Ihab Kamel, MD: The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, MRI 110B, Baltimore, MD 21287, USA
Wilfredo Mormontoy-Laurel, MD: Faculty of Sciences, Department of Statistics, Demography, Humanities and Social Sciences, Cayetano Heredia University, 430 Honorio Delgado Ave, Lima, LIMA 31, Peru
Ketty Dolores-Cerna, MD: Faculty of Sciences, Department of Statistics, Demography, Humanities and Social Sciences, Cayetano Heredia University, 430 Honorio Delgado Ave, Lima, LIMA 31, Peru
Jacsel Suarez, MD: Cayetano Heredia University School of Medicine, 430 Honorio Delgado Ave, Lima, LIMA 31, Peru
Sergio Perez-Melo, MD: Department of Mathematics and Statistics, Florida International University, S.W. 8th Street, DM 430, Miami, FL 33199, USA
David A. Bluemke, MD: Department of Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, 10 Center Drive, Rm 10/1C355, Bethesda, MD 20892, USA
Theodore P. Abraham, MD: Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA
Stefan L. Zimmerman, MD: The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, MRI 110B, Baltimore, MD 21287, USA
M. Roselle Abraham, MD: Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA

DOI: https://doi.org/10.1016/j.joa.2016.10.005
Journal volume & issue: Vol. 33, no. 3
pp. 201 – 207

Abstract

Read online

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.

Published in Journal of Arrhythmia

ISSN: 1880-4276 (Print); 1883-2148 (Online)
Publisher: Wiley
Country of publisher: Australia
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://onlinelibrary.wiley.com/journal/18832148

About the journal

Abstract

Keywords