Prevalence of scarred and dysfunctional myocardium in patients with heart failure of ischaemic origin: a cardiovascular magnetic resonance study
Author(s)
Type
Journal Article
Abstract
Background
Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) can provide unique data on the transmural extent of scar/viability. We assessed the prevalence of dysfunctional myocardium, including partial thickness scar, which could contribute to left ventricular contractile dysfunction in patients with heart failure and ischaemic heart disease who denied angina symptoms.
Methods
We invited patients with ischaemic heart disease and a left ventricular ejection fraction < 50% by echocardiography to have LGE CMR. Myocardial contractility and transmural extent of scar were assessed using a 17-segment model.
Results
The median age of the 193 patients enrolled was 70 (interquartile range: 63-76) years and 167 (87%) were men. Of 3281 myocardial segments assessed, 1759 (54%) were dysfunctional, of which 581 (33%) showed no scar, 623 (35%) had scar affecting ≤50% of wall thickness and 555 (32%) had scar affecting > 50% of wall thickness. Of 1522 segments with normal contractile function, only 98 (6%) had evidence of scar on CMR. Overall, 182 (94%) patients had ≥1 and 107 (55%) patients had ≥5 segments with contractile dysfunction that had no scar or ≤50% transmural scar suggesting viability.
Conclusions
In this cohort of patients with left ventricular systolic dysfunction and ischaemic heart disease, about half of all segments had contractile dysfunction but only one third of these had > 50% of the wall thickness affected by scar, suggesting that most dysfunctional segments could improve in response to an appropriate intervention.
Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) can provide unique data on the transmural extent of scar/viability. We assessed the prevalence of dysfunctional myocardium, including partial thickness scar, which could contribute to left ventricular contractile dysfunction in patients with heart failure and ischaemic heart disease who denied angina symptoms.
Methods
We invited patients with ischaemic heart disease and a left ventricular ejection fraction < 50% by echocardiography to have LGE CMR. Myocardial contractility and transmural extent of scar were assessed using a 17-segment model.
Results
The median age of the 193 patients enrolled was 70 (interquartile range: 63-76) years and 167 (87%) were men. Of 3281 myocardial segments assessed, 1759 (54%) were dysfunctional, of which 581 (33%) showed no scar, 623 (35%) had scar affecting ≤50% of wall thickness and 555 (32%) had scar affecting > 50% of wall thickness. Of 1522 segments with normal contractile function, only 98 (6%) had evidence of scar on CMR. Overall, 182 (94%) patients had ≥1 and 107 (55%) patients had ≥5 segments with contractile dysfunction that had no scar or ≤50% transmural scar suggesting viability.
Conclusions
In this cohort of patients with left ventricular systolic dysfunction and ischaemic heart disease, about half of all segments had contractile dysfunction but only one third of these had > 50% of the wall thickness affected by scar, suggesting that most dysfunctional segments could improve in response to an appropriate intervention.
Date Issued
2011-09-21
Date Acceptance
2011-09-21
Citation
Journal of Cardiovascular Magnetic Resonance, 2011, 13
ISSN
1532-429X
Publisher
BioMed Central
Journal / Book Title
Journal of Cardiovascular Magnetic Resonance
Volume
13
Copyright Statement
© Bourantas et al. 2011. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Radiology, Nuclear Medicine & Medical Imaging
Cardiovascular System & Cardiology
CARDIAC & CARDIOVASCULAR SYSTEMS
RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Heart failure
Myocardial infarction
Hibernation
Cardiovascular magnetic resonance imaging
Late gadolinium enhancement
LEFT-VENTRICULAR DYSFUNCTION
CORONARY-ARTERY-DISEASE
CARDIAC RESYNCHRONIZATION THERAPY
EMISSION-COMPUTED-TOMOGRAPHY
CONTRAST-ENHANCED MRI
SURGICAL REVASCULARIZATION
HIBERNATING MYOCARDIUM
VIABILITY
CARDIOMYOPATHY
ECHOCARDIOGRAPHY
Aged
Cicatrix
Contrast Media
Echocardiography
England
Female
Gadolinium DTPA
Heart Failure
Humans
Linear Models
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Myocardial Contraction
Myocardial Ischemia
Myocardium
Predictive Value of Tests
Prevalence
Prospective Studies
Stroke Volume
Tissue Survival
Ventricular Dysfunction, Left
Ventricular Function, Left
Nuclear Medicine & Medical Imaging
1102 Cardiovascular Medicine And Haematology
Publication Status
Published
Article Number
53