Cardiac Magnetic Resonance Imaging and Ventricular Tachycardias Involving the Sinuses of Valsalva in Patients With Nonischemic Cardiomyopathy.

Abstract

OBJECTIVES\nThe goal of this study was to investigate the relationship between cardiac scar on late gadolinium enhancement cardiac resonance imaging (LGE-CMR) and the presence of ventricular tachycardia (VT) ablation target sites within the sinuses of Valsalva (SV).\n\n\nBACKGROUND\nPatients with idiopathic dilated cardiomyopathy (IDCM) often have scarring involving the basal myocardium, including the SV, allowing targeting of VTs from within the SV.\n\n\nMETHODS\nForty-three consecutive patients with IDCM underwent a VT ablation procedure with pre-procedure LGE-CMR. Retrospectively, scar characteristics were compared between patients with and without VT target sites in the SV. The ratio between SV-related scarring and the total cardiac scarring was defined as the SV scar index: SV-related scarring/total cardiac scarring.\n\n\nRESULTS\nVT target sites were identified in the SV in 22 (51%) of 43 patients. LGE-CMR identified peri-aortic scarring involving the SV in 34 patients (79%). Scarring extended to the septum in 26 patients, involved the lateral basal wall in 4, and both areas in 13 patients. Scar volume within the SV was larger in patients with SV-VT targets (1.7 ± 0.9\xa0cm3 vs. 0.7 ± 0.6\xa0cm3; p\xa0<\xa00.0001) compared with other patients. A cutoff scar volume identifying SV-VT targets was 1.23\xa0cm3 in the short-axis view (area under the curve 0.82; sensitivity 0.64; specificity 0.91). The SV scar index was significantly greater in patients who had SV-VT target sites (0.33 ± 0.2 vs. 0.09 ± 0.09; p\xa0<\xa00.0001).\n\n\nCONCLUSIONS\nPatients with IDCM undergoing ablation of VT often have peri-aortic scarring visualized on LGE-CMR. Both the presence and the extent of scarring adjacent to the aortic annulus are associated with the presence of VT target sites within the SV.