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Clinical Significance of Late Enhancement and Regional Wall Remodeling Assessed by 3T Magnetic Resonance Imaging.

Larsen TH, Stugaard M, Rotevatn S, Nygård O, Nordrehaug JE - Clin Med Insights Cardiol (2015)

Bottom Line: LVRWR was identified by a significant reduction (≥50%) of the wall thickness.In the nonviable group, LVEF was significantly reduced (P < 0.001) compared to the viable group: ie, 50 ± 16% versus 61 ± 8%, and LVEF was significantly correlated to the number of nonviable segments (r = -0.66, P < 0.001).The presence of nonviable myocardium as detected by LGE at 3T CMR is associated with angiographically significant CAD, and is associated with the development of LVRWR and reduced LVEF.

View Article: PubMed Central - PubMed

Affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. ; Department of Biomedicine, University of Bergen, Bergen, Norway.

ABSTRACT

Background: Clinical follow-up studies comparing left ventricular (LV) function and late gadolinium enhancement (LGE) by high-field 3T cardiac magnetic resonance (CMR) are of general interest due to the increased use of 3T scanners. In this study, the occurrence of LGE and LV regional wall remodeling (RWR) was assessed by 3T CMR in patients undergoing coronary angiography for suspected stable coronary artery disease (CAD).

Materials and methods: Analysis of myocardial viability by LGE was performed at the segmental level. LVRWR was identified by a significant reduction (≥50%) of the wall thickness. Major adverse cardiovascular events (MACE) were registered during a median follow-up time of 58 (45-62) months.

Results: Of the 87 patients (59 ± 9 years; 13 women) enrolled, nonviable myocardium was detected in 35 (40%) and significant CAD in 69 (79%). Nonviable myocardium was correlated to angiographic significant stenosis or occlusion. LVRWR was significantly related to a higher number of nonviable segments compared to those without LVRWR: ie, 6.0 ± 3.2 segments versus 2.6 ± 1.3; P < 0.001. In the nonviable group, LVEF was significantly reduced (P < 0.001) compared to the viable group: ie, 50 ± 16% versus 61 ± 8%, and LVEF was significantly correlated to the number of nonviable segments (r = -0.66, P < 0.001). The number of nonviable segments by LGE was significantly associated with MACE by an odds ratio of 1.25 (95% CI, 1.05-1.49; P = 0.013).

Conclusion: The presence of nonviable myocardium as detected by LGE at 3T CMR is associated with angiographically significant CAD, and is associated with the development of LVRWR and reduced LVEF. Assessing the extent of nonviable myocardium by both LGE and LVRWR at the segmental level may therefore contribute to individualized risk stratification and treatment strategies.

No MeSH data available.


Related in: MedlinePlus

Viable myocardium.Notes: Demonstration of viable myocardium in a 73-year-old male, as reflected by the absence of LGE at CMR (lower panel) despite significant CAD of LAD and CX arteries as shown by coronary angiography (upper panel).
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f1-cmc-9-2015-017: Viable myocardium.Notes: Demonstration of viable myocardium in a 73-year-old male, as reflected by the absence of LGE at CMR (lower panel) despite significant CAD of LAD and CX arteries as shown by coronary angiography (upper panel).

Mentions: Significant CAD was detected in 69 of 87 patients (79%). LGE in the LV wall demonstrating nonviable myocardium was detected in 35 (40%) patients. All nonviable segments were related to the presence of significant stenosis or occlusion as confirmed by coronary angiography; moreover, nonviable segments were not detected in angiographically open vessels. Viable segments, on the other hand, were frequently found in territories with significant CAD (Figs. 1 and 2). The characteristics of the study population according to presence or absence of viable myocardium are summarized in Table 1. There was a significant gender difference, with more women in the viable group. Known chronic MIs (>3 months old), previous CABG, or PCI was overrepresented in the nonviable group, and LVEF was significantly decreased (P < 0.05): 50 ± 16% versus 61 ± 8%. A considerable number of the patients underwent PCI (39%, n = 34), either directly or during a second intervention, whereas 12% (n = 10) were scheduled for succeeding CABG.


Clinical Significance of Late Enhancement and Regional Wall Remodeling Assessed by 3T Magnetic Resonance Imaging.

Larsen TH, Stugaard M, Rotevatn S, Nygård O, Nordrehaug JE - Clin Med Insights Cardiol (2015)

Viable myocardium.Notes: Demonstration of viable myocardium in a 73-year-old male, as reflected by the absence of LGE at CMR (lower panel) despite significant CAD of LAD and CX arteries as shown by coronary angiography (upper panel).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4401245&req=5

f1-cmc-9-2015-017: Viable myocardium.Notes: Demonstration of viable myocardium in a 73-year-old male, as reflected by the absence of LGE at CMR (lower panel) despite significant CAD of LAD and CX arteries as shown by coronary angiography (upper panel).
Mentions: Significant CAD was detected in 69 of 87 patients (79%). LGE in the LV wall demonstrating nonviable myocardium was detected in 35 (40%) patients. All nonviable segments were related to the presence of significant stenosis or occlusion as confirmed by coronary angiography; moreover, nonviable segments were not detected in angiographically open vessels. Viable segments, on the other hand, were frequently found in territories with significant CAD (Figs. 1 and 2). The characteristics of the study population according to presence or absence of viable myocardium are summarized in Table 1. There was a significant gender difference, with more women in the viable group. Known chronic MIs (>3 months old), previous CABG, or PCI was overrepresented in the nonviable group, and LVEF was significantly decreased (P < 0.05): 50 ± 16% versus 61 ± 8%. A considerable number of the patients underwent PCI (39%, n = 34), either directly or during a second intervention, whereas 12% (n = 10) were scheduled for succeeding CABG.

Bottom Line: LVRWR was identified by a significant reduction (≥50%) of the wall thickness.In the nonviable group, LVEF was significantly reduced (P < 0.001) compared to the viable group: ie, 50 ± 16% versus 61 ± 8%, and LVEF was significantly correlated to the number of nonviable segments (r = -0.66, P < 0.001).The presence of nonviable myocardium as detected by LGE at 3T CMR is associated with angiographically significant CAD, and is associated with the development of LVRWR and reduced LVEF.

View Article: PubMed Central - PubMed

Affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. ; Department of Biomedicine, University of Bergen, Bergen, Norway.

ABSTRACT

Background: Clinical follow-up studies comparing left ventricular (LV) function and late gadolinium enhancement (LGE) by high-field 3T cardiac magnetic resonance (CMR) are of general interest due to the increased use of 3T scanners. In this study, the occurrence of LGE and LV regional wall remodeling (RWR) was assessed by 3T CMR in patients undergoing coronary angiography for suspected stable coronary artery disease (CAD).

Materials and methods: Analysis of myocardial viability by LGE was performed at the segmental level. LVRWR was identified by a significant reduction (≥50%) of the wall thickness. Major adverse cardiovascular events (MACE) were registered during a median follow-up time of 58 (45-62) months.

Results: Of the 87 patients (59 ± 9 years; 13 women) enrolled, nonviable myocardium was detected in 35 (40%) and significant CAD in 69 (79%). Nonviable myocardium was correlated to angiographic significant stenosis or occlusion. LVRWR was significantly related to a higher number of nonviable segments compared to those without LVRWR: ie, 6.0 ± 3.2 segments versus 2.6 ± 1.3; P < 0.001. In the nonviable group, LVEF was significantly reduced (P < 0.001) compared to the viable group: ie, 50 ± 16% versus 61 ± 8%, and LVEF was significantly correlated to the number of nonviable segments (r = -0.66, P < 0.001). The number of nonviable segments by LGE was significantly associated with MACE by an odds ratio of 1.25 (95% CI, 1.05-1.49; P = 0.013).

Conclusion: The presence of nonviable myocardium as detected by LGE at 3T CMR is associated with angiographically significant CAD, and is associated with the development of LVRWR and reduced LVEF. Assessing the extent of nonviable myocardium by both LGE and LVRWR at the segmental level may therefore contribute to individualized risk stratification and treatment strategies.

No MeSH data available.


Related in: MedlinePlus