TY - JOUR
T1 - Nonstress delayed-enhancement magnetic resonance imaging of the myocardium predicts improvement of function after revascularization for chronic ischemic heart disease with left ventricular dysfunction
AU - Schvartzman, Paulo R.
AU - Srichai, Monvadi B.
AU - Grimm, Richard A.
AU - Obuchowski, Nancy A.
AU - Hammer, Donald F.
AU - McCarthy, Patrick M.
AU - Kasper, Jane M.
AU - White, Richard D.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2003/9/1
Y1 - 2003/9/1
N2 - Background: The extent of myocardial scarring of the left ventricle (LV) is important in patients with chronic ischemic heart disease [CIHD). With delayed-enhancement magnetic resonance imaging (DE-MRI), scarred myocardium (hyper-enhanced) is easily distinguishable from viable (dark) myocardium. This investigation assessed the use of DE-MRI for predicting functional improvement after coronary artery bypass grafting (CABG) in patients with CIHD and significant LV dysfunction. Methods: The patient population (n = 29) with CIHD and LV dysfunction (ejection fraction 28% ± 10%) underwent both DE-MRI, to delineate scarred regions before revascularization, and echocardiography (Echo), to assess segmental function before and after CABG (interval 188 ± 57 days). Using a 16-segment model, LV myocardium was semiquantitatively analyzed for scarring based on DE-MRI and for improvements in resting function by pre- and post-CABG Echo. Results: Before CABG, 82% of targeted myocardial segments had abnormal contraction; 78% showed scarring, including 38% with greater than mild amounts (25%-100%). Normal contraction was found in 18% of segments before revascularization; scarred areas were identified in 42%, 84% of which had, at most, minimal amounts (0%-24%). Of segments with pre-CABG dysfunction, 82% with no evidence of scar recovered, compared to only 18% with ≥50% scarring. Amount of hyper-enhancement was a very good indicator of improvement of function, especially at the ≥50%/segment threshold; overall accuracy was 0.74 (95% CI 0.66-0.82, P < .001). Conclusions: In patients with CIHD and significant LV dysfunction, DE-MRI can predict likelihood of functional improvement after revascularization.
AB - Background: The extent of myocardial scarring of the left ventricle (LV) is important in patients with chronic ischemic heart disease [CIHD). With delayed-enhancement magnetic resonance imaging (DE-MRI), scarred myocardium (hyper-enhanced) is easily distinguishable from viable (dark) myocardium. This investigation assessed the use of DE-MRI for predicting functional improvement after coronary artery bypass grafting (CABG) in patients with CIHD and significant LV dysfunction. Methods: The patient population (n = 29) with CIHD and LV dysfunction (ejection fraction 28% ± 10%) underwent both DE-MRI, to delineate scarred regions before revascularization, and echocardiography (Echo), to assess segmental function before and after CABG (interval 188 ± 57 days). Using a 16-segment model, LV myocardium was semiquantitatively analyzed for scarring based on DE-MRI and for improvements in resting function by pre- and post-CABG Echo. Results: Before CABG, 82% of targeted myocardial segments had abnormal contraction; 78% showed scarring, including 38% with greater than mild amounts (25%-100%). Normal contraction was found in 18% of segments before revascularization; scarred areas were identified in 42%, 84% of which had, at most, minimal amounts (0%-24%). Of segments with pre-CABG dysfunction, 82% with no evidence of scar recovered, compared to only 18% with ≥50% scarring. Amount of hyper-enhancement was a very good indicator of improvement of function, especially at the ≥50%/segment threshold; overall accuracy was 0.74 (95% CI 0.66-0.82, P < .001). Conclusions: In patients with CIHD and significant LV dysfunction, DE-MRI can predict likelihood of functional improvement after revascularization.
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U2 - 10.1016/S0002-8703(03)00318-1
DO - 10.1016/S0002-8703(03)00318-1
M3 - Article
C2 - 12947375
AN - SCOPUS:0042332265
SN - 0002-8703
VL - 146
SP - 535
EP - 541
JO - American heart journal
JF - American heart journal
IS - 3
ER -