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    Ventricular tachycardia (VT) substrate characteristics: Insights from multimodality structural and functional imaging of the VT substrate using cardiac MRI scar, 123 I-metaiodobenzylguanidine SPECT innervation, and bipolar voltage

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    Author
    Imanli, H.
    Ume, K.L.
    Jeudy, J.
    Date
    2019
    Journal
    Journal of Nuclear Medicine
    Publisher
    Society of Nuclear Medicine Inc.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.2967/jnumed.118.211698
    Abstract
    Postischemic adaptation results in characteristic myocardial structural and functional changes in the ventricular tachycardia (VT) substrate. The aim of this study was to compare myocardial structural and functional adaptations (late gadolinium enhancement/abnormal innervation) with detailed VT mapping data to identify regional heterogeneities in postischemic changes. Methods: Fifteen patients with ischemic cardiomyopathy and drug-refractory VT underwent late gadolinium enhancement cardiac MRI (CMR), 123I-metaiodobenzylguanidine SPECT, and high-resolution bipolar voltage mapping to assess fibrosis (>3 SDs), abnormal innervation (<50% tracer uptake), and low-voltage area (<1.5 mV), respectively. Three-dimensional reconstructed CMR/123I-metaiodobenzylguanidine models were coregistered for further comparison. Results: Postischemic structural and functional adaptations in all 3 categories were similar in size (reported as median [quartile 1–quartile 3]: CMR scar, 46.1 cm2 [33.1–86.9 cm2]; abnormal innervation, 47.8 cm2 [40.5–68.1 cm2]; and low-voltage area, 29.5 cm2 [24.5–102.6 cm2]; P > 0.05). However, any single modality underestimated the total VT substrate area defined as abnormal in at least 1 of the 3 modalities (76.0 cm2 [57.9–143.2 cm2]; P < 0.001). Within the total VT substrate area, regions abnormal in all 3 modalities were most common (25.2%). However, significant parts of the VT substrate had undergone heterogeneous adaptation (abnormal in <3 modalities); the most common categories were “abnormal innervation only” (18.2%), “CMR scar plus abnormal innervation only” (14.9%), and “CMR scar only” (14.6%). All 14 VT channel/exit sites (0.88 ± 0.74 mV) were localized to myocardium demonstrating CMR scar and abnormal innervation. This specific tissue category accounted for 68.3% of the CMR scar and 31.2% of the total abnormal postischemic VT substrate area. Conclusion: Structural and functional imaging demonstrated regional heterogeneities in the postischemic VT substrate not appreciated by any single modality alone. The coexistence of abnormal innervation and CMR scar may identify a particularly “proarrhythmic” adaptation and may represent a potential novel target for VT ablation.
    Keyword
    Cardiac imaging
    Cardiac innervation
    Multimodality imaging
    Ventricular tachycardia
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85059503510&doi=10.2967%2fjnumed.118.211698&partnerID=40&md5=1f2b9e36dc9342ff8de9ba52d0a1e7bc; http://hdl.handle.net/10713/10817
    ae974a485f413a2113503eed53cd6c53
    10.2967/jnumed.118.211698
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    UMB Open Access Articles 2019

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