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1001 Greater degree of left ventricular scar is associated with increased mortality in patients with severe ischemic cardiomyopathy

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Journal of Cardiovascular Magnetic Resonance200810 (Suppl 1) :A126

  • Published:


  • Left Ventricular Ejection Fraction
  • Cardiac Transplantation
  • Left Ventricular Volume
  • Ischemic Cardiomyopathy
  • Myocardial Scar


Patients with ischemic cardiomyopathy (ICM) have reduced survival. Delayed hyperenhancement magnetic resonance imaging (DHE-MRI) accurately measures myocardial scar. We sought to determine if extent of left ventricular (LV) scar is associated with survival in severe ICM patients.


349 patients with severe ICM >/= 70% coronary artery disease in >/= 1 epicardial vessel on angiography, mean LV ejection fraction (EF) of 24%] that underwent DHE-MRI (Siemens 1.5 T scanner, Erlangen, Germany) from 2003–6 were studied. (Siemens, Erlangen, Germany) from 2005–6. DHE-MR images were obtained in standard long and short axis orientations (covering the entire LV), after injection of Gadolinium dimenglumine using an inversion recovery spoiled gradient echo sequence: TE 4 msec, TR 8 msec, flip angle 300, bandwidth 140 Hz/pixel, 23 k-space lines acquired every other RR-interval, field of view (varied from 228–330 in the x-direction and 260–330 in the y-direction) and matrix size (varied from 140–180 in the x-direction and 256 in the y-direction). For DHE-MRI analysis, a custom analysis package (VPT software, Siemens, Erlangen, Germany) was used to manually delineate endocardial and epicardial myocardial edges. Scar was defined (as % of myocardium in a 17-segment model on custom software, Siemens Research) on DHE-MR images, as intensity > 2 standard deviation above viable myocardium. Transmurality score was recorded in all segments as follows: 0 = no scar, 1 = 1–25% scar, 2 = 26–50%, 3 = 51–75% and 4 = > 75%. Total scar score was calculated as transmurality score for all segments/17. LV volumes, EF, demographics, risk factors, need for cardiac transplantation (CTx) and all-cause mortality were recorded. Figure 1.

Figure 1


There were 56 combined events (51 deaths and 5 CTx) over a follow up of 2.6 ± 1.2 years. Characteristics of patients with and without events is shown in the table in Figure 2. On receiver operating characteristic curve analysis, mean scar % predicted events (area under curve 0.62, p median of 2.3 (RR 1.96 [1.13–3.41]) and female gender (RR 1.83 [1.06–3.16]) predicted events (both p < 0.05).
Figure 2
Figure 2

Characteristics of patients with and without events.


In ICM patients with severely reduced LVEF, greater extent of myocardial scar on DHE-MRI is associated with worse outcomes, including mortality or need for cardiac transplantation.

Authors’ Affiliations

Cleveland Clinic Foundation, Cleveland, OH, USA


© Kwonf et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.