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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

Correlation plot between number of nonviable segments and LV EF in relation to LV RWR.Notes: This scatterplot shows the negative correlation between number of nonviable segments and LVEF in relation to LVRWR. Nonviable hearts are divided into four subgroups, ie, zero (0), low (0–3), medium (4–7), and high (≥8). Cases of LVRWR are depicted by green circles and of no RWR by blue triangles.
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f5-cmc-9-2015-017: Correlation plot between number of nonviable segments and LV EF in relation to LV RWR.Notes: This scatterplot shows the negative correlation between number of nonviable segments and LVEF in relation to LVRWR. Nonviable hearts are divided into four subgroups, ie, zero (0), low (0–3), medium (4–7), and high (≥8). Cases of LVRWR are depicted by green circles and of no RWR by blue triangles.

Mentions: Transmurality as well as the segmental localization and distribution of nonviable myocardium was evaluated and compared to the angiographic findings (Figs. 3 and 4). Of the 35 patients with nonviable myocardium, the number of these segments with regard to the corresponding blood supply territories was comparable: LAD n = 18 segments, CX n = 17, and RCA n = 21. Further, the frequency of nonviable segments depicting subendocardial, transmural, or combined subendocardial and transmural nonviable myocardium was not statistically different for the three vessel territories. For the LAD territory, the presence of subendocardial, transmural, and combined nonviable myocardium was 5% (n = 1), 67% (12), 28% (5); for the CX territory 12% (n = 2), 47% (8), 41% (7); and for RCA territory 0% (n = 0), 52% (11), 48% (10). When allocating the patients with nonviable myocardium into three subgroups according to the number of nonviable segments, ie, low 0–3 segments, medium 4–7 segments, and high ≥8 segments, in addition to the group with only viable myocardium, a significant negative correlation to LVEF was noted (Fig. 5). Moreover, the nonviable myocardium with evidence of LVRWR, 66% (n = 23), appeared mainly in the groups with medium and high numbers of nonviable segments (Fig. 5). Hence, in nonviable hearts with LVRWR, the average number of nonviable segments was 6.0 ± 3.2, whereas the number of segments was significantly lower (P < 0.001), 2.6 ± 1.3, in hearts without LVRWR. Further, in hearts with nonviable myocardium and LVRWR, LVEF was significantly reduced (P < 0.001) compared to nonviable hearts without LVRWR, ie, 44 ± 17% versus 62 ± 8%. When comparing patients with stable versus unstable angina, a significant difference in the presence of nonviable segments was found, ie, 1.5 ± 2.6 versus 3.9 ± 4.3 (P = 0.007), respectively.


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)

Correlation plot between number of nonviable segments and LV EF in relation to LV RWR.Notes: This scatterplot shows the negative correlation between number of nonviable segments and LVEF in relation to LVRWR. Nonviable hearts are divided into four subgroups, ie, zero (0), low (0–3), medium (4–7), and high (≥8). Cases of LVRWR are depicted by green circles and of no RWR by blue triangles.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f5-cmc-9-2015-017: Correlation plot between number of nonviable segments and LV EF in relation to LV RWR.Notes: This scatterplot shows the negative correlation between number of nonviable segments and LVEF in relation to LVRWR. Nonviable hearts are divided into four subgroups, ie, zero (0), low (0–3), medium (4–7), and high (≥8). Cases of LVRWR are depicted by green circles and of no RWR by blue triangles.
Mentions: Transmurality as well as the segmental localization and distribution of nonviable myocardium was evaluated and compared to the angiographic findings (Figs. 3 and 4). Of the 35 patients with nonviable myocardium, the number of these segments with regard to the corresponding blood supply territories was comparable: LAD n = 18 segments, CX n = 17, and RCA n = 21. Further, the frequency of nonviable segments depicting subendocardial, transmural, or combined subendocardial and transmural nonviable myocardium was not statistically different for the three vessel territories. For the LAD territory, the presence of subendocardial, transmural, and combined nonviable myocardium was 5% (n = 1), 67% (12), 28% (5); for the CX territory 12% (n = 2), 47% (8), 41% (7); and for RCA territory 0% (n = 0), 52% (11), 48% (10). When allocating the patients with nonviable myocardium into three subgroups according to the number of nonviable segments, ie, low 0–3 segments, medium 4–7 segments, and high ≥8 segments, in addition to the group with only viable myocardium, a significant negative correlation to LVEF was noted (Fig. 5). Moreover, the nonviable myocardium with evidence of LVRWR, 66% (n = 23), appeared mainly in the groups with medium and high numbers of nonviable segments (Fig. 5). Hence, in nonviable hearts with LVRWR, the average number of nonviable segments was 6.0 ± 3.2, whereas the number of segments was significantly lower (P < 0.001), 2.6 ± 1.3, in hearts without LVRWR. Further, in hearts with nonviable myocardium and LVRWR, LVEF was significantly reduced (P < 0.001) compared to nonviable hearts without LVRWR, ie, 44 ± 17% versus 62 ± 8%. When comparing patients with stable versus unstable angina, a significant difference in the presence of nonviable segments was found, ie, 1.5 ± 2.6 versus 3.9 ± 4.3 (P = 0.007), respectively.

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