Association Between Myocardial Scar Burden and Left Ventricular Ejection Fraction in Ischemic Cardiomyopathy

Abstract

Background This study was conducted to assess the relationship between scar burden (extent and severity) and the follow-up left ventricular ejection fraction (LVEF). Methods Patients 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. Results The 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). Conclusions The 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.

Construction of a web‐based dynamic nomogram for predicting the prognosis in acute heart failure

“…demonstrated a significant negative association between myocardial scar burden and CRT response regardless of baseline dyssynchrony. In a multivariable analysis of 178 patients with HF who received standard drug therapy, after adjusting for left anterior descending artery, total scar score was found to be a significant predictor of LVEF change 19 . Moreover, a retrospective study demonstrated that myocardial scar was independently associated with an increased risk of a composite of all‐cause death, heart transplantation, acute coronary syndrome, hospitalization for HF, and late revascularization 18 .…”

“…In a multivariable analysis of 178 patients with HF who received standard drug therapy, after adjusting for left anterior descending artery, total scar score was found to be a significant predictor of LVEF change. 19 Moreover, a retrospective study demonstrated that myocardial scar was independently associated with an increased risk of a composite of all-cause death, heart transplantation, acute coronary syndrome, hospitalization for HF, and late revascularization. 18 This study also showed that rest scar burden was an independent predictor of the prognosis of AHF with an HR (95% CI) of 1.03 (1.01-1.06).…”

“…Our previous study further reveals that the combination of phase histogram bandwidth >77.76° and QRS duration >120 ms may improve risk prediction of patients with AHF 17 . In addition, clinically meaningful improvements in cardiac resynchronization therapy (CRT) response, LV ejection fraction (LVEF), and the incidence of major adverse cardiovascular events are seen in patients with lower myocardial scar burden 18–20 . However, no studies have been conducted to establish a clinical prediction model using ECG‐gated SPECT MPI to date.…”

“…17 In addition, clinically meaningful improvements in cardiac resynchronization therapy (CRT) response, LV ejection fraction (LVEF), and the incidence of major adverse cardiovascular events are seen in patients with lower myocardial scar burden. [18][19][20] However, no studies have been conducted to establish a clinical prediction model using ECG-gated SPECT MPI to date.…”

Combined Serum Albumin and Left Ventricular Ejection Fraction Predict All-Cause Death in Patients with Stable Coronary Artery Disease

“…Left ventricular ejection fraction (LVEF) is an important index to measure left ventricular systolic function and guide medical treatment of HF [ 15 ]. It is also an important indicator for evaluating the prognosis of coronary heart disease [ 16 , 17 ]. At present, there was no report about the prognosis of SCAD by combined Alb and LVEF.…”