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Infarct Characterization and Quantification by Delayed Enhancement Cardiac Magnetic Resonance Imaging Is a Powerful Independent and Incremental Predictor of Mortality in Patients With Advanced Ischemic Cardiomyopathy

Citation

Kwon, DH and Asamoto, L and Popovic, ZB and Kusunose, K and Robinson, M and Desai, M and Marwick, TH and Flamm, SD, Infarct Characterization and Quantification by Delayed Enhancement Cardiac Magnetic Resonance Imaging Is a Powerful Independent and Incremental Predictor of Mortality in Patients With Advanced Ischemic Cardiomyopathy, Circulation. Cardiovascular Imaging, 7, (5) pp. 796-804. ISSN 1942-0080 (2014) [Refereed Article]

Copyright Statement

Copyright 2014 American Heart Association, Inc.

DOI: doi:10.1161/CIRCIMAGING.114.002077

Abstract

BACKGROUND: -Infarct heterogeneity has been shown to be independently associated with adverse outcomes in previous smaller studies. However, it is unknown if infarct characterization is an independent predictor of all-cause mortality in patients with advanced ischemic cardiomyopathy (ICM), after adjusting for clinical risk factors, severity of ischemic mitral regurgitation, incomplete revascularization, and device therapy. METHODS AND RESULTS: -A total of 362 patients with ICM (LV dysfunction with >70% stenosis in ≥1 epicardial coronary artery) underwent delayed hyperenhancement-MRI and coronary angiography between 2002 and 2006. Total myocardial scar (TMS) and peri-infarct (PI) area was measured utilizing various threshold techniques. Multivariate survival analysis, (primary end-point of all-cause mortality) was conducted. One hundred fifty-seven deaths occurred over a mean 5.4 year follow-up (mean LVEF 239%, mean ESVi 11348 ml, mean TMS% 25.516.0%, mean PI% 5.72.9%. PI% ( 2.07, p<0.001) was an independent predictor of survival, independent of age, end systolic volume, gender, mitral regurgitation, renal function, diabetes, dyslipidemia, coronary artery disease severity, implantable cardioverter defibrillator (ICD), and incomplete revascularization. PI% utilizing 2-3SD technique yielded the highest incremental prognostic power (χ2 score 149). CONCLUSIONS: -In advanced ICM, PI% is a powerful independent and incremental predictor of all-cause mortality. Infarct heterogeneity offers substantial further risk stratification compared to quantification of TMS% alone even after adjusting for clinical risk factors, end systolic volume index, mitral regurgitation, incomplete revascularization, and ICD implantation.

Item Details

Item Type:Refereed Article
Keywords:ischemic cardiomyopathy; magnetic resonance imaging; survival; viability imaging
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, TH (Professor Tom Marwick)
ID Code:93524
Year Published:2014
Web of Science® Times Cited:7
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-08-06
Last Modified:2017-11-02
Downloads:0

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