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Prediction of global left ventricular functional recovery in patients with heart failure undergoing surgical revascularisation, based on late gadolinium enhancement cardiovascular magnetic resonance.

Pegg TJ, Selvanayagam JB, Jennifer J, Francis JM, Karamitsos TD, Dall'Armellina E, Smith KL, Taggart DP, Neubauer S - J Cardiovasc Magn Reson (2010)

Bottom Line: Mean LVEF 38% ± 11, which improved to 43% ± 12 after surgery. 21/33 patients improved EF by ≥3% (EF before 38% ± 13, after 47% ± 13), 12/33 did not (EF before 39% ± 6, after 37% ± 8).Based on a 50% transmural viability cutoff, patients with ≥10 viable+normal segments improve global LV function post revascularisation, while patients with fewer such segments do not.LGE-CMR is a simple and powerful tool for identifying which patients with impaired LV function will benefit from CABG.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Oxford Centre for Clinical Magnetic Resonance Research, UK.

ABSTRACT

Background: The new gold standard for myocardial viability assessment is late gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR); this technique has demonstrated that the transmural extent of scar predicts segmental functional recovery. We now asked how the number of viable and number of viable+normal, segments predicted recovery of global left ventricular (LV) function in patients undergoing CABG. Finally, we examined which segmental transmural threshold of scarring best predicted global LV recovery.

Methods and results: Fifty patients with reduced LV ejection fraction (EF) referred for CABG were recruited, and 33 included in this analysis. Patients underwent CMR to assess LV function and viability pre-operatively at 6 days and 6 months. Mean LVEF 38% ± 11, which improved to 43% ± 12 after surgery. 21/33 patients improved EF by ≥3% (EF before 38% ± 13, after 47% ± 13), 12/33 did not (EF before 39% ± 6, after 37% ± 8). The only independent predictor for global functional recovery after revascularisation was the number of viable+normal segments: Based on a segmental transmural viability cutoff of <50%, ROC analysis demonstrated ≥10 viable+normal segments predicted ≥3% improvement in LVEF with a sensitivity of 95% and specificity of 75% (AUC = 0.9, p < 0.001). Transmural viability cutoffs of <25 and <75% and a cutoff of ≥4 viable segments were less useful predictors of global LV recovery.

Conclusions: Based on a 50% transmural viability cutoff, patients with ≥10 viable+normal segments improve global LV function post revascularisation, while patients with fewer such segments do not. LGE-CMR is a simple and powerful tool for identifying which patients with impaired LV function will benefit from CABG.

Trial registration: Research Ethics Committee Unique Identifier: NRES:05/Q1603/42. The study is listed on the Current Controlled Trials Registry: ISRCTN41388968.URL: http://www.controlled-trials.com.

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Relationship between the transmural extent of scar and functional recovery on a segmental basis.
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Figure 2: Relationship between the transmural extent of scar and functional recovery on a segmental basis.

Mentions: Prior to defining predictors of global recovery we wanted to ensure that the previously described relationship between transmural extent of viability and regional function recovery holds true for this cohort of patients with more severely impaired LV function. For this purpose it was necessary to use a 40 or 48 segment model similar to previous work[5,14]. A total of 1408 segments were available for analysis, of which 957 segments were judged to be dysfunctional before revascularisation (68%). Furthermore, 718 segments had some degree of LGE (51%). In dysfunctional segments, there was progressive reduction in functional recovery with increasing extent of transmural infarction (p < 0.001) (Figure 2).


Prediction of global left ventricular functional recovery in patients with heart failure undergoing surgical revascularisation, based on late gadolinium enhancement cardiovascular magnetic resonance.

Pegg TJ, Selvanayagam JB, Jennifer J, Francis JM, Karamitsos TD, Dall'Armellina E, Smith KL, Taggart DP, Neubauer S - J Cardiovasc Magn Reson (2010)

Relationship between the transmural extent of scar and functional recovery on a segmental basis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2959056&req=5

Figure 2: Relationship between the transmural extent of scar and functional recovery on a segmental basis.
Mentions: Prior to defining predictors of global recovery we wanted to ensure that the previously described relationship between transmural extent of viability and regional function recovery holds true for this cohort of patients with more severely impaired LV function. For this purpose it was necessary to use a 40 or 48 segment model similar to previous work[5,14]. A total of 1408 segments were available for analysis, of which 957 segments were judged to be dysfunctional before revascularisation (68%). Furthermore, 718 segments had some degree of LGE (51%). In dysfunctional segments, there was progressive reduction in functional recovery with increasing extent of transmural infarction (p < 0.001) (Figure 2).

Bottom Line: Mean LVEF 38% ± 11, which improved to 43% ± 12 after surgery. 21/33 patients improved EF by ≥3% (EF before 38% ± 13, after 47% ± 13), 12/33 did not (EF before 39% ± 6, after 37% ± 8).Based on a 50% transmural viability cutoff, patients with ≥10 viable+normal segments improve global LV function post revascularisation, while patients with fewer such segments do not.LGE-CMR is a simple and powerful tool for identifying which patients with impaired LV function will benefit from CABG.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Oxford Centre for Clinical Magnetic Resonance Research, UK.

ABSTRACT

Background: The new gold standard for myocardial viability assessment is late gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR); this technique has demonstrated that the transmural extent of scar predicts segmental functional recovery. We now asked how the number of viable and number of viable+normal, segments predicted recovery of global left ventricular (LV) function in patients undergoing CABG. Finally, we examined which segmental transmural threshold of scarring best predicted global LV recovery.

Methods and results: Fifty patients with reduced LV ejection fraction (EF) referred for CABG were recruited, and 33 included in this analysis. Patients underwent CMR to assess LV function and viability pre-operatively at 6 days and 6 months. Mean LVEF 38% ± 11, which improved to 43% ± 12 after surgery. 21/33 patients improved EF by ≥3% (EF before 38% ± 13, after 47% ± 13), 12/33 did not (EF before 39% ± 6, after 37% ± 8). The only independent predictor for global functional recovery after revascularisation was the number of viable+normal segments: Based on a segmental transmural viability cutoff of <50%, ROC analysis demonstrated ≥10 viable+normal segments predicted ≥3% improvement in LVEF with a sensitivity of 95% and specificity of 75% (AUC = 0.9, p < 0.001). Transmural viability cutoffs of <25 and <75% and a cutoff of ≥4 viable segments were less useful predictors of global LV recovery.

Conclusions: Based on a 50% transmural viability cutoff, patients with ≥10 viable+normal segments improve global LV function post revascularisation, while patients with fewer such segments do not. LGE-CMR is a simple and powerful tool for identifying which patients with impaired LV function will benefit from CABG.

Trial registration: Research Ethics Committee Unique Identifier: NRES:05/Q1603/42. The study is listed on the Current Controlled Trials Registry: ISRCTN41388968.URL: http://www.controlled-trials.com.

Show MeSH
Related in: MedlinePlus