Prediction of global left ventricular functional recovery in patients with heart failure undergoing surgical revascularisation, based on late gadolinium enhancement Cardiovascular Magnetic Resonance

Abstract

BackgroundThe new gold standard for myocardial viability assessment is late gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR); this technique has demonstrated that the transmural extent of scar predicts segmental functional recovery. We now asked how the number of viable and number of viable+normal, segments predicted recovery of global left ventricular (LV) function in patients undergoing CABG. Finally, we examined which segmental transmural threshold of scarring best predicted global LV recovery.Methods and ResultsFifty patients with reduced LV ejection fraction (EF) referred for CABG were recruited, and 33 included in this analysis. Patients underwent CMR to assess LV function and viability pre-operatively at 6 days and 6 months. Mean LVEF 38% ± 11, which improved to 43% ± 12 after surgery. 21/33 patients improved EF by ≥3% (EF before 38% ± 13, after 47% ± 13), 12/33 did not (EF before 39% ± 6, after 37% ± 8). The only independent predictor for global functional recovery after revascularisation was the number of viable+normal segments: Based on a segmental transmural viability cutoff of <50%, ROC analysis demonstrated ≥10 viable+normal segments predicted ≥3% improvement in LVEF with a sensitivity of 95% and specificity of 75% (AUC = 0.9, p < 0.001). Transmural viability cutoffs of <25 and <75% and a cutoff of ≥4 viable segments were less useful predictors of global LV recovery.ConclusionsBased on a 50% transmural viability cutoff, patients with ≥10 viable+normal segments improve global LV function post revascularisation, while patients with fewer such segments do not. LGE-CMR is a simple and powerful tool for identifying which patients with impaired LV function will benefit from CABG.Trial registrationResearch Ethics Committee Unique Identifier: NRES:05/Q1603/42. The study is listed on the Current Controlled Trials Registry: ISRCTN41388968.URL: http://www.controlled-trials.com

MRI-based prediction of adverse cardiac remodeling after murine myocardial infarction

“…This is most likely related to variations in the severity and extent of myocardial injury that is induced by coronary ligation in mouse models (15,23,28,29). The ability in such preclinical models to predict at an early stage whether a sufficient infarction has been induced to result in significant delayed remodeling would be invaluable in improving the design, throughput, and efficiency of such studies.In clinical practice, the prediction of delayed cardiac remodeling is an important aim that aids decisions regarding early therapy (8,10,16). Many different methods of such prediction have been studied among which imaging modalities such as cardiac magnetic resonance imaging (MRI), which provide accurate and reproducible assessment of functional and volumetric parameters of the left ventricle in vivo, are considered especially promising (2, 6, 9, 13, 16).…”

“…In clinical practice, the prediction of delayed cardiac remodeling is an important aim that aids decisions regarding early therapy (8,10,16). Many different methods of such prediction have been studied among which imaging modalities such as cardiac magnetic resonance imaging (MRI), which provide accurate and reproducible assessment of functional and volumetric parameters of the left ventricle in vivo, are considered especially promising (2, 6, 9, 13, 16).…”

“…Many different methods of such prediction have been studied among which imaging modalities such as cardiac magnetic resonance imaging (MRI), which provide accurate and reproducible assessment of functional and volumetric parameters of the left ventricle in vivo, are considered especially promising (2,6,9,13,16). MRI has high accuracy in quantifying not only volumes and mass in remodeling murine heart but also infarct size (IS; Refs.…”

Imaging-Guided Selection of Patients With Ischemic Heart Failure for High-Risk Revascularization Improves Identification of Those With the Highest Clinical Benefit

“…Although the experience with contrast-enhanced MRI (CMR) is more limited, recent results suggest that it offers similar predictive accuracies as those seen with DSE. [37][38][39] Scar can be easily detected using late gadolinium enhancement. The extent of myocardial scar has been associated with myocardial recovery, increased mortality, or the need for cardiac transplantation.…”

Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics

“…The transmural extension of scars showed correlation with the potential contractile recovery, described by Kim et al 10 Infarcted areas are < 50% more likely to functional improvement after revascularization, while those > 50% are associated with poorer outcomes. 19 In a meta-analysis of 24 studies, Romero et al compared these three techniques. The use of dobutamine stress showed better specificity and positive predictive value, while LGE was associated with better sensitivity and negative predictive value.…”