Author + information
- Received June 9, 2008
- Revision received August 29, 2008
- Accepted September 9, 2008
- Published online January 1, 2009.
- Deborah H. Kwon, MD⁎,
- Carmel M. Halley, MD⁎,
- Thomas P. Carrigan, MD†,
- Victoria Zysek, DO†,
- Zoran B. Popovic, MD, PhD⁎,
- Randolph Setser, PhD‡,
- Paul Schoenhagen, MD⁎,‡,
- Randall C. Starling, MD, MPH⁎,
- Scott D. Flamm, MD⁎,‡ and
- Milind Y. Desai, MD⁎,‡,⁎ ()
Reprint requests and correspondence:
Dr. Milind Y. Desai, Department of Cardiovascular Medicine, Desk F 15, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195
Objectives The objective of the study was to determine whether the extent of left ventricular scar, measured with delayed hyperenhancement cardiac magnetic resonance (DHE-CMR), predicts survival in patients with ischemic cardiomyopathy (ICM) and severely reduced left ventricular ejection fraction (LVEF).
Background Patients with ICM and reduced LVEF have poor survival. Such patients have a high myocardial scar burden. CMR is highly accurate in delineation of myocardial scar.
Methods We studied 349 patients (76% men) with severe ICM (≥70% disease in ≥1 epicardial coronary, and mean LVEF of 24%) that underwent DHE-CMR (Siemens 1.5-T scanner, Erlangen, Germany), between 2003 and 2006. Scar (quantified as percentage of myocardium) was defined on DHE-MR images as an intensity >2 standard deviations above the viable myocardium. Transmurality score was semiquantitatively recorded in a 17-segment model as: 0 = no scar, 1 = 1% to 25% scar, 2 = 26% to 50%, 3 = 51% to 75%, and 4 = >75%. The LVEF, demographic data, risk factors, need for cardiac transplantation (CTx), and all-cause mortality were recorded.
Results The mean age and follow-up were 65 ± 11 years and 2.6 ± 1.2 years (median 2.4 years [1.1, 3.5]), respectively. There were 56 events (51 deaths and 5 CTx). Mean scar percentage and transmurality score were higher in patients with events versus those without (39 ± 22 vs. 30 ± 20, p = 0.003, and 9.7 ± 5 vs. 7.8 ± 5, p = 0.004). On Cox proportional hazard survival analysis, quantified scar was greater than the median (30% of total myocardium), and female gender predicted events (relative risk 1.75 [95% Confidence Interval: 1.02 to 3.03] and relative risk 1.83 [95% Confidence Interval: 1.06 to 3.16], respectively, both p = 0.03).
Conclusions In patients with ICM and severely reduced LVEF, a greater extent of myocardial scar, delineated by DHE-CMR is associated with increased mortality or the need for cardiac transplantation, potentially aiding further risk-stratification.
The institution receives modest research support from Siemens Medical Solutions.
- Received June 9, 2008.
- Revision received August 29, 2008.
- Accepted September 9, 2008.
- American College of Cardiology Foundation