Abstract
BackgroundThis study was conducted to assess the relationship between scar burden (extent and severity) and the follow-up left ventricular ejection fraction (LVEF).MethodsPatients were referred for viability assessment with late gadolinium enhancement (LGE) on cardiovascular magnetic resonance imaging. To measure the transmural extent of LGE in each segment (scar score), we used a five-point scale system. Baseline ejection fraction (EF) and at follow-up were recorded. LVEF classified as non-severe and severely depressed.ResultsThe study included 178 patients (males: 88.8%; mean age: 57.1±10.02 years; mean baseline LVEF: 28.61±10.39). In patients with severe baseline LVEF, the mean scar percentage was higher than that in patients who had non-severe LVEF (38.8±19.41 vs. 24.61±21.21; p˂0.001). On linear regression analysis, aldosterone antagonist and total scar score significantly predicted follow-up ejection fraction (EF) (B=-7.083, p˂0.001 and B=-3.038, p=0.038, respectively). Left anterior descending artery (LAD) territory viability and baseline EF significantly predicted change in EF in patients with LVEF ≤ 35% (B=5.389, p=0.009 and B=-0.581, p˂0.001, respectively). On binary regression analysis for the prediction of at least 5% improvement in EF in patients with baseline EF ≤ 35%, baseline EF and LAD viability were significant (B=-0.15, p=0.014 and B=1.042 and p=0.054, respectively).ConclusionsThe extent of myocardial scar and viability of LAD territory are identified as the important and independent parameters for the predictions of improvement in EF even after adjustment for demographics and baseline EF and following the standards of care medication.
Highlights
Magnitude of the problemCurrently, more than five million patients have been diagnosed with heart failure (HF), with the figures still rising and over 650,000 new cases diagnosed annually [1]
Patients were referred for viability assessment with late gadolinium enhancement (LGE) on cardiovascular magnetic resonance imaging
Left anterior descending artery (LAD) territory viability and baseline ejection fraction (EF) significantly predicted change in EF in patients with left ventricular ejection fraction (LVEF) ≤ 35% (B=5.389, p=0.009 and B=0.581, p0.001, respectively)
Summary
Magnitude of the problemCurrently, more than five million patients have been diagnosed with heart failure (HF), with the figures still rising and over 650,000 new cases diagnosed annually [1]. The survival of HF patients have improved, the absolute mortality rates of HF patients remains 50% if diagnosed within five years of its occurrence [2]. Coronary artery disease (CAD) with a history of myocardial infraction (MI) is a major cause of HF with reduced ejection fraction (EF) and ischemic cardiomyopathy (ICM). [3] It is estimated that CAD may cause more than 11 million deaths globally [4] in the 20 years [5]. Mortality rates in ICM patients with severely depressed EF are significantly higher than the general patient [6]. This study was conducted to assess the relationship between scar burden (extent and severity) and the follow-up left ventricular ejection fraction (LVEF)
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