{"id":"e4f15f31f80c","type":"article","url":"https://hartvaat.nl/2026/01/09/littekenweefsel-voorspelt-plotse-hartdood-na-een-infarct-grotendeels-buiten-de-e/","title":"Littekenweefsel voorspelt plotse hartdood na een infarct grotendeels buiten de ejectiefractie om","title_en":"Replacement fibrosis, left ventricular ejection fraction and sudden cardiac death in patients after myocardial infarction: a mediation analysis","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","hfmref","hfpef","hfref","laminopathie","myocardinfarct","ouderen","plotse-hartdood","ventrikelfibrilleren"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003799?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003799?rss=1","authors":["Zhou","P.","Aisikaier","K.","Dong","Z.","Ma","X.","Tang","Y.","Wei","Z.","Jia","X.","Chen","X.","Liu","Y.","Xu","W.","Sa","F.","Yang","S.-J.","Wang","J.","Zhao","F.","Lu","M.","Zhao","X.","Chen","X.","Zhao","S."],"significance":6,"published":"2026-01-09","source_date":"2026-01-09","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/cardiale-mri/","https://hartvaat.nl/kennis/ritmestoornissen/arvc-aritmogene-rechterventrikeldysplasie/"],"congress":"","summary_en":"Selection for an implantable defibrillator (ICD) after myocardial infarction relies mainly on reduced ejection fraction (LVEF), which may not capture the full risk of sudden cardiac death (SCD). In this retrospective study (917 post-infarction patients, cardiac MRI, median follow-up 63 months), the extent to which LVEF explains the link between replacement fibrosis (measured by late gadolinium enhancement, LGE) and SCD was examined. Over follow-up, 65 patients (7.1%) had an SCD event. More LGE was associated with lower LVEF, and both LGE and LVEF independently predicted SCD. In a mediation analysis, however, LVEF explained only 19.7% of LGE's effect on SCD — 40.4% in patients with LVEF >35%, while there was no mediation in those with LVEF ≤35%. Scar tissue thus predicts sudden cardiac death largely independent of ejection fraction; LVEF alone is an inadequate risk measure, whether above or below 35%.","created":"2026-07-03T10:32:27Z","updated":"2026-07-03T18:39:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De selectie voor een implanteerbare defibrillator (ICD) na een hartinfarct berust vooral op een verminderde ejectiefractie (LVEF), maar die vangt mogelijk niet het hele risico op plotse hartdood (SCD). In deze retrospectieve studie (917 post-infarctpatiënten, cardiale MRI, mediane follow-up 63 maanden) werd onderzocht in hoeverre de LVEF het verband tussen vervangingsfibrose (gemeten met late gadolinium-aankleuring, LGE) en SCD verklaart. Over de follow-up kregen 65 patiënten (7,1%) een SCD-event. Meer LGE hing samen met een lagere LVEF, en zowel LGE als LVEF voorspelden onafhankelijk SCD. In een mediatieanalyse verklaarde de LVEF echter slechts 19,7% van het effect van LGE op SCD — bij patiënten met een LVEF >35% 40,4%, terwijl er bij een LVEF ≤35% geen mediatie was. Littekenweefsel voorspelt plotse hartdood dus grotendeels los van de ejectiefractie; LVEF alleen schiet tekort als risicomaat, ongeacht of die boven of onder de 35% ligt.","abstract_original":"<sec><st>Objective</st>\n<p>To evaluate the potential mediating role of left ventricular ejection fraction (LVEF) in the relationship between replacement fibrosis (assessed by late gadolinium enhancement (LGE)) and sudden cardiac death (SCD) post-myocardial infarction (MI) and also to assess this mediation effect in subgroups based on LVEF &le; 35% and &gt; 35% according to implantable cardioverter-defibrillator (ICD) selection criterion.</p>\n</sec>\n<sec><st>Methods</st>\n<p>A retrospective analysis was conducted on 917 post-MI patients (mean age: 56.3&plusmn;11.0 years, 88.8% male) who underwent cardiac MR from January 2017 to August 2021. The endpoint for SCDs included SCD, aborted SCD and appropriate ICD discharges. The association of LGE with LVEF was quantified using linear regression models. The associations of LGE and LVEF with SCDs were evaluated using competing risk models. Mediation analysis was then used to decompose the total effect of LGE on SCDs into direct and indirect (mediated through LVEF) effects using accelerated failure time models.</p>\n</sec>\n<sec><st>Results</st>\n<p>Over a median follow-up of 63.3 (IQR, 43.6 to 76.6) months, 65 patients (7.1%) experienced SCDs. In all patients, LGE was significantly associated with lower LVEF (&beta;=-0.35, <I>p</I>&lt;0.001). Both LGE and LVEF independently predicted SCDs (subdistribution hazard ratio (sHR)=1.06, <I>p</I>&lt;0.001; sHR=0.95, <I>p</I>=0.03, respectively). Mediation analysis showed that LVEF accounted for 19.7% of the total effect of LGE on SCDs (<I>p</I>&lt;0.001). This mediation effect was 40.4% in patients with LVEF &gt; 35% (<I>p</I> = 0.02), while no mediation was observed in patients with LVEF &le; 35% (<I>p</I> = 0.08).</p>\n</sec>\n<sec><st>Conclusion</st>\n<p>LVEF partially mediated the effect of LGE on the SCD, accounting for less than one-fifth of the total effect. LVEF alone inadequately captured the whole SCD risk, irrespective of whether LVEF is greater than 35% or 35% or less.</p>\n</sec>"}