Abstract
BackgroundSome patients may have normal wall motion after myocardial infarction. The aim of this study was to determine the prevalence and prognosis of patients with myocardial scar in the absence of abnormal wall motion. We studied patients with suspected or known coronary artery disease (CAD) who were referred for cardiovascular magnetic resonance (CMR) for the assessment of global and regional cardiac function and late gadolinium enhancement (LGE) and had normal left ventricular wall motion. Prognostic value was determined by the occurrence of hard endpoints (cardiac death and nonfatal myocardial infarction) and major adverse cardiac events (MACE) which also included hospitalization due to unstable angina or heart failure or life threatening ventricular arrhythmia.ResultsA total 1148 patients (70.3%) were studied. LGE was detected in 104 patients (9.1%). Prevalence of LGE increased in patients with increased left ventricular mass. Average follow-up time was 955 ± 542 days. LGE was the strongest predictor for hard endpoints and MACE.ConclusionLGE was detected in 9.1% of patients with suspected or known CAD and normal wall motion. LGE was the strongest predictor of significant cardiac events.
Highlights
Some patients may have normal wall motion after myocardial infarction
We excluded 248 patients with a history of revascularization, 252 patients with a history of myocardial infarction, 18 patients who were unable to complete cardiovascular magnetic resonance (CMR) examination, 8 patients with inadequate image quality, 4 patients with pacemakers, 5 patients with unstable clinical conditions, 14 patients unobtainable clinical follow-up data, 10 patients with mid-wall or patchy scar likely to be nonischemia cardiomyopathy scar, 3 patients with scar at the insertion site of right ventricular free-wall likely to be related to hypertrophic cardiomyopathy, 2 patients with subepicardial scar likely to be related to myocarditis, and 1 patient with diffuse late gadolinium enhancement (LGE) likely to be related to amyloidosis
The following factors were associated with LGE: male gender, hypercholesterolemia, hypertension, a history of dyspnea on exertion, use of certain medications such as angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), and statin
Summary
Some patients may have normal wall motion after myocardial infarction. The aim of this study was to determine the prevalence and prognosis of patients with myocardial scar in the absence of abnormal wall motion. We studied patients with suspected or known coronary artery disease (CAD) who were referred for cardiovascular magnetic resonance (CMR) for the assessment of global and regional cardiac function and late gadolinium enhancement (LGE) and had normal left ventricular wall motion. Cardiovascular magnetic resonance (CMR) is considered the gold standard for the assessment of global ventricular function [9,10] and a good tool for the assessment of regional ventricular function [11] It provides the data concerning myocardial scar, most commonly related to myocardial infarction, by LGE technique. This technique has been proven to be very accurate, comparable to histopathology [12], and have better accuracy than single photon emission computed tomography [12,13], even in the setting of very small infarction [14], and it has been shown to be highly reproducible [15]
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