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

Background

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.

Methods

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.

figure1

Figure 1

Results

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
figure2

Characteristics of patients with and without events.

Conclusion

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.

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Correspondence to Deborah H Kwonf.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Kwonf, D.H., Halley, C.H., Carrigan, T.P. et al. 1001 Greater degree of left ventricular scar is associated with increased mortality in patients with severe ischemic cardiomyopathy. J Cardiovasc Magn Reson 10, A126 (2008). https://doi.org/10.1186/1532-429X-10-S1-A126

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Keywords

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