Abstract 3098: Left Ventricular Delayed Hyper-enhancement Further Risk Stratifies Patients with Severe Systolic Dysfunction Regardless of the Presence of Coronary Artery Disease: A Cardiac MRI Study

Abstract

Background: Patients with severe systolic left ventricular (LV) dysfunction have poor survival. Delayed hyperenhancement magnetic resonance imaging (DHE-MRI) accurately measures myocardial scar. In patients with severe systolic LV dysfunction, it is unclear if presence of scar further impacts survival. We sought to determine if presence of LV scar further risk-stratifies patients with severe LV dysfunction. Methods: We studied 199 consecutive patients with LV systolic dysfunction who underwent DHE-MRI (Siemens 1.5 T scanner, Erlangen, Germany) from 2005– 6. The percentage of myocardial scar was determined semi-quantitatively on DHE-MR images, in a standard 17-segment model using custom software (Siemens Research), and defined as intensity >2 standard deviation above viable myocardium. Transmurality score was recorded in all segments as follows: 0 = no scar, 1 = 1–25% scar, 2 = 26 –50 %, 3 = 51–75% and 4 = > 75%. Global LV scar burden was calculated as total transmurality score for all segments/17. LV ejection fraction (EF) and end-diastolic diameter (EDD) were recorded from echocardiography. Presence of coronary artery disease (CAD) and all-cause mortality were recorded. Results: In a median follow up of 1.6 years [1, 1.9], 26 (13 %) patients died. Characteristics of survivors vs. non-survivors are detailed in Table . Survival in patients with any amount of LV scar had significantly worse 1-year survival compared to those without (log-rank p = 0.03). Median global LV scar burden was 1.8 [1, 2.5]. On receiver operating characteristic curve analysis, global scar burden > 1.8 was predictive of death (area under curve 0.61, p = 0.05). Patients with scar burden > 1.8 also had significantly worse 1-year survival compared to those with scar burden ≤ 1.8 (log rank p = 0.03). Conclusions: In patients with severe systolic LV dysfunction, higher LV myocardial scar burden, detected on DHE-MRI is associated with worse survival, despite similar LVEF, LVEDD, and prevalence of CAD. Table