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The combined incremental prognostic value of left ventricular ejection fraction, late gadolinium enhancement and global circumferential strain assessed by cardiovascular magnetic resonance

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We aimed to assess the incremental prognostic value of GCS measured using tagging for the prediction of major adverse cardiovascular events in addition to baseline clinical characteristics, LVEF and late gadolinium enhancement (LGE) in an unselected cohort of patients... The combined primary endpoint was cardiovascular death, heart failure hospitalization and sustained ventricular arrhythmia requiring hospitalization or defibrillator therapy. 58 patients suffered the primary outcome over the mean follow-up period of 2.2 years... History of pre-existent ischemic heart disease and beta-blocker use were both significant clinical predictors of adverse outcome... All 3 CMR parameters were significant multivariable predictors of the primary outcome when added to significant clinical predictors (LVEF: HR 0.97; 95% CI 0.94-0.99, p=0.01; presence of LGE: HR 2.12; 95% CI 1.03-4.37, p=0.041; GCS: HR 1.10; 95% CI 1.02-1.20, p=0.019)... Global χ increased significantly with the addition of both LGE and GCS... Both the presence of LGE and GCS <-12.1% had independent prognostic value in the whole cohort and in patients with LVEF ≥35%... Additionally, patients with LVEF >35%, LGE present and reduced GCS (<-12.1%) had an equivalently poor prognosis to patients with LVEF <35%... We found in a large cohort of patients that GCS has incremental independent prognostic value in addition to clinical variables, LVEF and LGE... Furthermore, patients with LVEF >35% but reduced strain and LGE present have an equivalently poor prognosis to those with LVEF <35% and may benefit from more intensive life-saving therapy... The additional use of tagging and LGE may provide further risk stratification of patients to help guide management.

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An example of the protocol with cine imaging, LGE and GCS in a normal patient (top) and a patient with severe LVSD (bottom).
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Figure 1: An example of the protocol with cine imaging, LGE and GCS in a normal patient (top) and a patient with severe LVSD (bottom).


The combined incremental prognostic value of left ventricular ejection fraction, late gadolinium enhancement and global circumferential strain assessed by cardiovascular magnetic resonance
An example of the protocol with cine imaging, LGE and GCS in a normal patient (top) and a patient with severe LVSD (bottom).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4328968&req=5

Figure 1: An example of the protocol with cine imaging, LGE and GCS in a normal patient (top) and a patient with severe LVSD (bottom).

View Article: PubMed Central - HTML

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

We aimed to assess the incremental prognostic value of GCS measured using tagging for the prediction of major adverse cardiovascular events in addition to baseline clinical characteristics, LVEF and late gadolinium enhancement (LGE) in an unselected cohort of patients... The combined primary endpoint was cardiovascular death, heart failure hospitalization and sustained ventricular arrhythmia requiring hospitalization or defibrillator therapy. 58 patients suffered the primary outcome over the mean follow-up period of 2.2 years... History of pre-existent ischemic heart disease and beta-blocker use were both significant clinical predictors of adverse outcome... All 3 CMR parameters were significant multivariable predictors of the primary outcome when added to significant clinical predictors (LVEF: HR 0.97; 95% CI 0.94-0.99, p=0.01; presence of LGE: HR 2.12; 95% CI 1.03-4.37, p=0.041; GCS: HR 1.10; 95% CI 1.02-1.20, p=0.019)... Global χ increased significantly with the addition of both LGE and GCS... Both the presence of LGE and GCS <-12.1% had independent prognostic value in the whole cohort and in patients with LVEF ≥35%... Additionally, patients with LVEF >35%, LGE present and reduced GCS (<-12.1%) had an equivalently poor prognosis to patients with LVEF <35%... We found in a large cohort of patients that GCS has incremental independent prognostic value in addition to clinical variables, LVEF and LGE... Furthermore, patients with LVEF >35% but reduced strain and LGE present have an equivalently poor prognosis to those with LVEF <35% and may benefit from more intensive life-saving therapy... The additional use of tagging and LGE may provide further risk stratification of patients to help guide management.

No MeSH data available.