Abstract
BackgroundLate gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) predicts adverse prognosis in patients with stable coronary artery disease (CAD). However, the interaction with conventional risk factors remains uncertain. Our aim was to assess whether the extent of LGE is an independent predictor of adverse cardiac outcome beyond conventional risk factors, including left ventricle ejection fraction (LVEF).MethodsWe enrolled 376 patients (88% males, 64 ± 11 years) with stable CAD, who underwent LGE assessment and a detailed conventional evaluation (clinical and pharmacological history, risk factors, ECG, Echocardiography). During a follow-up of 38 ± 21 months, 56 events occurred (32 deaths, 24 hospitalizations for heart failure).ResultsLGE and LVEF showed the strongest univariate associations with end-points (HR: 13.61 [95%C.I.: 7.32-25.31] for LGE ≥ 45% of LV mass; and 12.34 [6.80-22.38] for LVEF ≤ 30%; p < 0.0001). Multivariate analysis identified baseline LVEF, loop diuretic therapy, moderate-severe mitral regurgitation and pulmonary hypertension as significant predictors among conventional risk factors. According to a step-wise approach, LGE showed strong association with prognosis as well (5.25 [2.64-10.43]; p < 0.0001). LGE significantly improved the model predictability (chi-square 239 vs 221, F-test p < 0.0001) with an additive effect on the prognostic power of LVEF, which however retained its prognostic power (4.89 [2.50-09.56]; p < 0.0001). Patients with LGE ≥ 45% and/or LVEF ≤ 30% had much worse prognosis compared to patients without risk factors (annual event rates of 43% vs 3%; p < 0.0001). Interestingly LGE was a significant predictor when all cause mortality was analyzed as the only endpoint.ConclusionsThis study demonstrates that LGE assessed by CMR is a robust independent non-invasive marker of prognosis in stable CAD patients. LGE can integrate the available metrics to substantially improve risk stratification.
Highlights
Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) predicts adverse prognosis in patients with stable coronary artery disease (CAD)
Conflicting results have been found in patients with stable CAD and unrecognized myocardial infarction (MI), with LGE prognostic power being incremental or alternative to left ventricle ejection fraction (LVEF) at multivariate analysis [4,8]
Further studies are warranted to assess the usefulness of LGE as selection criterion for major therapeutic decision such as cardiac resynchronization therapy (CRT) or automatic implantable cardioverterdefibrillator (AICD), findings of the present study promote the inclusion of LGE into current clinical management of patients with stable CAD, especially of those with reduced LVEF at echocardiography
Summary
Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) predicts adverse prognosis in patients with stable coronary artery disease (CAD). Previous studies suggested that LGE predicts adverse prognosis in patients with stable coronary artery disease (CAD) [4,5,6,7,8,9]. Since it predicts unfavourable left with reduced LVEF [7]. The aim of our study was to assess whether, in a large well-characterized population of patients with known or suspected stable CAD the extent of LGE is an independent predictor of adverse outcome in the long-term beyond conventional risk factors, in particular LVEF
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