Author + information
- Fahad Saleh Almehmadi,
- Immaculate Nevis,
- Mohammad Zahrani,
- Mahmoud Bokhari,
- John Stirrat,
- Raymond Yee and
- James A. White
Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is increasingly being performed in the evaluation of patients with systolic dysfunction. Abnormal patterns of hyper-enhancement (HE) are commonly identified and reported. However, the prognostic significance of such findings remains uncertain. This study aimed to evaluate the role of abnormal HE patterns to predict cardiovascular outcomes among patients with systolic dysfunction.
Three-hundred eighteen consecutive patients with cardiomyopathy referred for LGE-CMR with an LVEF <55% were followed for the primary composite endpoint of; cardiac death, heart failure admission or appropriate ICD therapy. Standard cine image datasets were analyzed for both LV and RV volumes and ejection fraction (EF) calculated. LGE images were blindly scored for the presence of HE and its pattern categorized as follows; subendocardial, mid-wall striae, mid-wall patchy, RV insertion site, sub-epicardial, and diffuse. Total HE volume was quantified using a signal threshold of ≥5SD above reference mean myocardial signal, and Borderzone HE volume was quantified using the difference between ≥3 and ≥5SD threshold measurements.
Mean age was 62.0±12.9 and the mean LVEF was 32.6±11.9%. Any HE was reported in 243 patients (76%) with HE patterns reported as follows; ischemic: 146 (46%); mid-wall striae: 57 (18%); mid-wall patchy: 35 (11%); RV insertion site: 51 (16%); sub-epicardial: 34 (11%); and diffuse: 9 (3%). At a median follow-up of 778 days 61 patients (19.1%) had suffered a primary outcome. Among all baseline characteristics only LVESV, LVEF, RVEF, Total HE volume and mid-wall striae were significantly associated with the primary outcome (p<0.05). Multivariate Cox regression analysis showed mid-wall striae to be the strongest independent predictor of the primary outcome with a HR of 2.6 (95%CI 1.5-4.7, p=0.001). At 2 years, event-free survival was 62% versus 87% in those with and without mid-wall striae pattern HE, respectively.
Mid-wall striae pattern HE is the strongest independent predictor of cardiovascular events in patients referred for the CMR evaluation of systolic dysfunction.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Imaging: MRI II Clinical Outcomes and CMR
Abstract Category: 19. Imaging: MRI
Presentation Number: 1138M-316
- 2013 American College of Cardiology Foundation