Background
In many genetic and acquired non-ischaemic cardiomyopathies (NICM) there have been
frequent reports of involvement of the interventricular septum (IVS) by late gadolinium
enhancement (LGE) at cardiac magnetic resonance (CMR). However, no studies have investigated
the relationship between septal LGE and arrhythmias in different NICM subtypes.
Methods
This study enrolled 103 patients with septal LGE at baseline CMR and different NICM:
hypertrophic (n=29) or lamin A/C gene (LMNA)-associated (n=23) cardiomyopathy, and
acute (n=30) or previous (n=21) myocarditis. During follow-up, the occurrences of
malignant ventricular arrhythmias (MVA) and major bradyarrhythmias (BA) were evaluated.
Results
At 4.9±0.7 years of follow-up, the occurrence of MVA and major BA in genetic vs acquired
NICM were 10 of 52 vs 12 of 51, and 10 of 52 vs 4 of 51, respectively (both p=n.s.).
However, MVA occurred more frequently in LMNA-NICM (eight of 23 vs two of 29 hypertrophic,
p=0.015) and in previous myocarditis (nine of 21 vs three of 30 acute, p=0.016), while
major BAs were particularly common in LMNA-NICM patients only (nine of 23 vs one of
29 hypertrophic, p=0.003). Different patterns of septal LGE were consistently retrospectively
identified at baseline CMR: junctional and limited to the base in 79.3% of uneventful
hypertrophic NICM; extended and focally transmural in LMNA-NICM with follow-up arrhythmias
(both p<0.05); transitory in patients with acute myocarditis, who, differently from
the post-myocarditis ones, showed follow-up arrhythmias only in the presence of unmodified
LGE at follow-up CMR (five of 13, p=0.009).
Conclusion
Septal LGE was significantly associated with MVA at the 5-year follow-up in LMNA-NICM
or previous myocarditis, and with major BA in LMNA-NICM only. These differences correlated
with heterogeneous patterns of IVS LGE in different NICM.
Keywords
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Article info
Publication history
Published online: October 08, 2019
Accepted:
August 30,
2019
Received in revised form:
August 25,
2019
Received:
May 14,
2019
Identification
Copyright
© 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
