The relationship between the structural features of postinfarction myocardium and cardiac arrhythmias

Background. Transformation of the morphology of the post-infarction myocardium changes the electrical characteristics of the heart muscle, increasing the risk of life-threatening arrhythmias.

Objective. The aim of the study was to compare the structural and electrical features of the heart muscle in post-infarction patients.

Design and methods. The study participants were 105 (85.4 %) patients who had suffered an MI, aged 56.7±8.4 years. Six months after the MI, the patients underwent cardiac magnetic resonance imaging (MRI) (GE SIGNA Voyager tomograph, GE HealthCare, USA) with the introduction of a contrast agent — gadoteric acid. Six and 12 months after the MI, the patients underwent multi-day electrocardiogram monitoring (MMEKG) for 72 hours.

Results. According to MMEKG, unstable paroxysms of VT were registered in 9 (6.8 %) patients. Frequent (>30/h) ventricular extrasystoles (VE) were correlated with the percentage of scar zone — r=0.679 (p=0.0101), the mass of the heterogeneous zone — r=0.721 (p=0.00951). An association was established between polymorphic VE with the presence of areas of microvascular obstruction r=0.812 (p=0.0095) and intramyocardial hemorrhage r=0.798 (p=0.0114). Most parameters of autonomic regulation and heart rate turbulence showed a moderate negative relationship with the scar mass. According to the data of univariate regression analysis, risk markers of unstable VT were established: scar zone mass, end-diastolic size, turbulence slope, SDNN variability parameter.

Conclusion. Predictors of unstable runs of ventricular tachycardias within 12 months after myocardial infarction are the mass of the scar zone, the values of the left ventricular end-diastolic diameter, the values of the turbulence slope and the SDNN variability parameter.

1. Oleynikov VE, Rogoza AN, Averyanova EV et. al. The advantages of multi-day telemetric monitoring of an electrocardiogram in patients who have suffered a myocardial infarction. Cardiological Bulletin. 2024; 19(2): 39–46. (In Russ.). Олейников В.Э., Рогоза А.Н., Аверьянова Е.В. и др. Преимущества многосуточного телеметрического мониторирования электрокардиограммы у пациентов, перенесших инфаркт миокарда. Кардиологический вестник. 2024; 19(2): 39–46. doi: 10.17116/Cardiobulletin20241902139.

2. Salari N., Morddarvanjoghi F., Abdolmaleki A., Rasoulpoor S., Khaleghi AA, Hezarkhani LA, Shohaimi S., Mohammadi M. The global prevalence of myocardial infarction: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2023 Apr 22; 23(1): 206. doi: 10.1186/s12872-023-03231-w.

3. Scalise RM, Sarro RD, Caracciolo A, Lauro R, Squadrito F, Carerj S, Bitto A, Micari A, Bella GD, Costa F, Irrera N. Fibrosis after myocardial infarction: an overview on cellular processes, molecular pathways, clinical evaluation and prognostic value. Med Sci (Basel). 2021; 9(1): 16. doi: 10.3390/medsci9010016.

4. Leancă SA, Crișu D, Petriș AO, Afrăsânie I, Genes A, Costache AD, Tesloianu DN, Costache II. Left Ventricular Remodeling after Myocardial Infarction: From Physiopathology to Treatment. Life (Basel). 2022 Jul 24;12(8):1111. doi: 10.3390/life12081111

5. Vyas R, Changal KH, Bhuta S, Pasadyn V, Katterle K, Niedoba M, Vora K, Dharmakumar R, Gupta R. Impact of intramyocardial hemorrhage on clinical outcomes in ST-elevation myocardial infarction: a systematic review and meta-analysis. J Soc Cardiovasc Angiogr Interv. 2022, 1100444. doi:10.1016/j.jscai.2022.100444.

6. Peek N, Hindricks G, Akbarov A, Tijssen JG. Sudden cardiac death after myocardial infarction: individual participant data from pooled cohorts. Eur Heart J. 2024; 45(43): 4616-4626. doi: 10.1093/eurheartj/ehae326.

7. Rusak TV, Gelis LG, Miadzvedzeva AA, et al. Cardiac structural and functional changes in ischemia-reperfusion injury of myocardium. Eurasian heart journal. 2022;(3):74-82. (In Russ.) Русак Т. В., Гелис Л. Г., Медведева Е. А. и др. Структурно-функциональные изменения сердца при ишемически-реперфузионном повреждении миокарда. Евразийский Кардиологический Журнал. 2022;(3):74-82. doi:10.38109/2225-1685-2022-3-74-82.

8. Garcia MJ, Kwong RY, Scherrer-Crosbie M, Taub CC, Blankstein R, Lima J, Bonow RO, Eshtehardi P, Bois JP. American heart association council on cardiovascular radiology and intervention and council on clinical cardiology. State of the art: imaging for myocardial viability: A scientific statement from the American Heart Association. Circ Cardiovasc Imaging. 2020, 13. doi: 10.1161/HCI.0000000000000053

9. Wang Y, Li Q, Tao B, Angelini M, Ramadoss S, Sun B, Wang P. Fibroblasts in heart scar tissue directly regulate cardiac excitability and arrhythmogenesis. Science. 2023; 381(6665): 1480-1487. doi: 10.1126/science.adh9925.

10. 2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction. Russian Journal of Cardiology. 2020; 25(11): 4103. (In Russ.) Острый инфаркт миокарда с подъемом сегмента ST электрокардиограммы. Клинические рекомендации 2020. Российский кардиологический журнал, 2020: 25 (11): 4103. doi: 10.15829/29/1560-4071-2020-4103.

11. Аверьянова Е.В., Тонкоглаз А.А., Чернова А.А., Донецкая Н.А., Олейников В.Э. Комплексная модель многофакторного прогнозирования жизнеугрожающих желудочковых нарушений ритма у больных инфарктом миокарда. Кардиоваскулярная терапия и профилактика. 2025;24(1):4215. doi: 10.15829/1728-8800-2025-4215. EDN: OODLYB

12. Jáuregui B., Soto-Iglesias D, Penela D., Acosta J., Fernández-Armenta J. Cardiovascular magnetic resonance determinants of ventricular arrhythmic events after myocardial infarction. Europace, 2022 Jul 15;24(6):938-947. doi: 10.1093/europace/euab275.

13. Dandel M., Javier M.F., Javier Delmo E.M., Loebe M., Hetzer R. Weaning from ventricular assist device support after recovery from left ventricular failure with or without secondary right ventricular failure. Cardiovasc Diagn Ther. 2021;11(1):226-242. doi: 10.21037/cdt-20-288.

14. Лебедев Д.С., Михайлов Е.Н., Неминущий Н.М., Голухова Е.З., Бабокин В.Е., Березницкая В.В. и др. Желудочковые нарушения ритма. Желудочковые тахикардии и внезапная сердечная смерть. Клинические рекомендации 2020. Российский кардиологический журнал. 2021; 26(7): 4600. DOI: 10.15829/1560-4071-2021-4600.

15. Dandel M., Javier M.F., Javier Delmo E.M., Loebe M., Hetzer R. Weaning from ventricular assist device support after recovery from left ventricular failure with or without secondary right ventricular failure. Cardiovasc Diagn Ther. 2021 Feb;11(1):226-242. doi: 10.21037/cdt-20-288.

16. Nikoo M. H., Naeemi R., Moarefl A., Attar A. Global longitudinal strain for prediction of ventricular arrhythmia in patients with heart failure. ESC heart failure. 2020; 7(5), 2956–2961. doi: 10.1002/ehf2.12910.

17. Zamahina O.V., Bunova S.S., Usacheva E.V., Nelidova A.V., SHerstyuk S.A., ZHenatov A.B. Remodeling of the left ventricle of the heart depending on the autonomic status in patients with myocardial infarction. Modern problems of science and education. 2016; 3: 347-354 (In Russ). Замахина О.В., Бунова С.С., Усачева Е.В., Нелидова А.В., Шерстюк С.А., Женатов А.Б. Ремоделирование левого желудочка сердца в зависимости от вегетативного статуса у больных, перенесших инфаркт миокарда. Современные проблемы науки и образования. 2016; 3: 347-354.