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. 2022 May;15(5):783-792.
doi: 10.1016/j.jcmg.2021.12.003. Epub 2022 Feb 16.

Entropy as a Measure of Myocardial Tissue Heterogeneity in Patients With Ventricular Arrhythmias

Panagiotis Antiochos  1 , Yin Ge  2 , Rob J van der Geest  3 , Chaitanya Madamanchi  2 , Iqra Qamar  2 , Ayako Seno  2 , Michael Jerosch-Herold  2 , Usha B Tedrow  4 , William G Stevenson  5 , Raymond Y Kwong  6
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Free article

Entropy as a Measure of Myocardial Tissue Heterogeneity in Patients With Ventricular Arrhythmias

Panagiotis Antiochos et al. JACC Cardiovasc Imaging. 2022 May.
Free article

Abstract

Objectives: The authors investigated the incremental prognostic value of entropy, a novel measure of myocardial tissue heterogeneity by cardiac magnetic resonance (CMR) imaging in patients presenting with ventricular arrhythmias (VAs).

Background: CMR can characterize myocardial areas serving as arrhythmogenic substrate.

Methods: Consecutive patients undergoing CMR imaging for VAs were followed for major adverse cardiac events (MACEs) defined by all-cause death, incident VAs requiring therapy, or heart failure hospitalization. Entropy was derived from the probability distribution of pixel signal intensities of the left ventricular (LV) myocardium.

Results: A total of 583 patients (age 54 ± 15 years, female 39%, left ventricular ejection fraction [LVEF] 54 ± 13%) were followed for a median of 4.4 years and experienced 141 MACEs. Entropy showed strong unadjusted association with MACE (HR: 1.88; 95% CI: 1.63-2.17; P < 0.001). In a multivariable model including LVEF, QRS duration, late gadolinium enhancement, and presenting arrhythmia, entropy maintained independent association with MACE (HR: 1.61; 95% CI: 1.32-1.96; P < 0.001). Entropy was further significantly associated with MACE in patients without myocardial scar (HR: 2.43; 95% CI: 1.55-3.82; P < 0.001) and in those presenting with nonsustained VAs (HR: 2.16; 95% CI: 1.43-3.25; P < 0.001). Addition of LV entropy to the baseline multivariable model significantly improved model performance (C-statistic improvement: 0.725 to 0.754; P = 0.003) and risk reclassification.

Conclusions: In patients with VAs, CMR-assessed LV entropy was independently associated with MACE and provided incremental prognostic value, on top of LVEF and late gadolinium enhancement. LV entropy assessment may help risk stratification in patients with absence of myocardial scar or with nonsustained VAs.

Keywords: cardiovascular magnetic resonance; entropy; myocardial tissue heterogeneity; prognosis; ventricular arrhythmia.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Antiochos has received research funding from the Swiss National Science Foundation (grant P2LAP3_184037), the Novartis Foundation for Medical-Biological Research, the Bangerter-Rhyner Foundation, and the SICPA Foundation, Switzerland. Dr Stevenson has received speaking honoraria from Abbott, Biotronik, Boston Scientific, Johnson and Johnson; has received consulting fees from Novartis; and is coholder of a patent for irrigated needle ablation that is consigned to the Brigham and Women’s hospital. All other authors have reported that they have no relationships relevant to the contents of this paper.

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