changes within the RV that are associated with adverse surgical outcomes and poorer prognosis following mitral valve surgery. Future studies are needed to confirm whether LGE is a new imaging biomarker that can be used to risk stratify severe asymptomatic MR patients for surgery. Abstract 110 Table 1 Features of patients with and without gadolinium enhancement Late gadolinium enhancement Number of patients MR fraction (%) Systolic RV volume (ml/ m 2) RV ejection fraction (%) Peak VO 2 (ml/ kg/min) VE/ VCO 2 None 43 32±12 28.5±7.7 61±8 24.6±6.9 31.1 ±5.0 RV insertion gadolinium 8 46±17* 31.4±7.6* 55±6* 23.1±8.7 33.2 ±3.2* LV myocardial gadolinium 10 42±19* 35.1±11.1* 55±8* 23.0±5.9 36.7 ±6.9* *denotes statistical significance of P0.05 compared to non-gadolinium cohort on Independent samples 2 tailed T-Test Abstract 110 Figure 1 Late gadolinium enhancement of the basal inferolateral LV
Midwall fibrosis is an independent predictor of mortality and morbidity in patients with DCM undergoing CRT. The outcome of DCM with midwall fibrosis is similar to that of ICM. This relationship is mediated by both pump failure and sudden cardiac death.
BackgroundLeft ventricular (LV) mid-wall fibrosis (MWF), which occurs in about a quarter of patients with non-ischemic cardiomyopathy (NICM), is associated with high risk of pump failure. The mid LV wall is the site of circumferential myocardial fibers. We sought to determine the effect of MWF on LV myocardial mechanics.MethodsPatients with NICM (n = 116; age: 62.8 ± 13.2 years; 67 % male) underwent late gadolinium enhancement cardiovascular magnetic resonance (CMR) and were categorized according to the presence (+) or absence (−) of MWF. Feature tracking (FT) CMR was used to assess myocardial deformation.ResultsDespite a similar LVEF (24.3 vs 27.5 %, p = 0.20), patients with MWF (32 [24 %]) had lower global circumferential strain (Ɛcc: −6.6 % vs −9.4 %, P = 0.004), but similar longitudinal (Ɛll: −7.6 % vs. −9.4 %, p = 0.053) and radial (Ɛrr: 14.6 % vs. 17.8 % p = 0.18) strain. Compared with − MWF, + MWF was associated with reduced LV systolic, circumferential strain rate (−0.38 ± 0.1 vs −0.56 ± 0.3 s−1, p = 0.005) and peak LV twist (4.65 vs. 6.31°, p = 0.004), as well as rigid LV body rotation (64 % vs 28 %, P <0.001). In addition, +MWF was associated with reduced LV diastolic strain rates (DSRcc: 0.34 vs. 0.46 s−1; DSRll: 0.38 vs. 0.50s−1; DSRrr: −0.55 vs. −0.75 s−1; all p <0.05).ConclusionsMWF is associated with reduced LV global circumferential strain, strain rate and torsion. In addition, MWF is associated with rigid LV body rotation and reduced diastolic strain rates. These systolic and diastolic disturbances may be related to the increased risk of pump failure observed in patients with NICM and MWF.
A PL scar is associated with a worse clinical outcome following CRT, particularly if it is transmural. Pacing scarred left ventricular myocardium carries a greater risk of mortality and morbidity than pacing nonscarred myocardium.
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