Scar quantification by cardiovascular magnetic resonance as an independent predictor of long-term survival in patients with ischemic heart failure treated by coronary artery bypass graft surgery.
Scar quantification by cardiovascular magnetic resonance as an independent predictor of long-term survival in patients with ischemic heart failure treated by coronary artery bypass graft surgery.
- 2016
Available online from MWHC library: 2008 - present
BACKGROUND: Scar burden by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is associated with functional recovery after coronary artery bypass surgery (CABG). There is limited data on long-term mortality after CABG based on left ventricular (LV) scar burden. CONCLUSION: In patients undergoing surgical revascularization, scar burden is negatively associated with survival in patients with scar. However, there is no difference in survival based on presence or absence of scar alone. CMR prior to CABG adds additional prognostic information. METHODS: Patients who underwent LGE CMR between January 2003 and February 2010 within 1 month prior to CABG were included. A standard 16 segment model was used for scar quantification. A score of 1 for no scar, 2 for<50 % and 3 for>50 % transmurality was assigned for each segment. LV scar score (LVSS) defined as the sum of segment scores divided by 16. All-cause mortality was ascertained by social security death index. RESULTS: One hundred ninety-six patients met the inclusion criteria. 185 CMR studies were available. History of prior MI was present in 64 % and prior CABG in 5.4 % of patients. Scar was present in 72 % of patients and median LVEF was 38 %. Over a median follow up of 8.3 years, there were 64 deaths (34.6 %). There was no statistically significant difference in mortality between Scar and No-scar groups (37 % versus 29 %). In the group with scar, a lower scar burden (defined either<4 segments with scar or based on LVSS) was independently associated with increased survival.
English
1097-6647
*Cardiomyopathies/dg [Diagnostic Imaging]
*Cicatrix/dg [Diagnostic Imaging]
*Coronary Artery Bypass
*Coronary Artery Disease/su [Surgery]
*Heart Failure/dg [Diagnostic Imaging]
*Magnetic Resonance Imaging, Cine
*Myocardial Infarction/dg [Diagnostic Imaging]
*Myocardium/pa [Pathology]
Aged
Cardiomyopathies/mo [Mortality]
Cardiomyopathies/pp [Physiopathology]
Cicatrix/mo [Mortality]
Cicatrix/pp [Physiopathology]
Contrast Media/ad [Administration & Dosage]
Coronary Artery Bypass/ae [Adverse Effects]
Coronary Artery Bypass/mo [Mortality]
Coronary Artery Disease/dg [Diagnostic Imaging]
Coronary Artery Disease/mo [Mortality]
Databases, Factual
Female
Heart Failure/mo [Mortality]
Heart Failure/pp [Physiopathology]
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction/mo [Mortality]
Myocardial Infarction/pp [Physiopathology]
Predictive Value of Tests
Proportional Hazards Models
Recovery of Function
Retrospective Studies
Risk Factors
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
MedStar Health Research Institute
MedStar Heart & Vascular Institute
MedStar Washington Hospital Center
Medicine
Journal Article
Available online from MWHC library: 2008 - present
BACKGROUND: Scar burden by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is associated with functional recovery after coronary artery bypass surgery (CABG). There is limited data on long-term mortality after CABG based on left ventricular (LV) scar burden. CONCLUSION: In patients undergoing surgical revascularization, scar burden is negatively associated with survival in patients with scar. However, there is no difference in survival based on presence or absence of scar alone. CMR prior to CABG adds additional prognostic information. METHODS: Patients who underwent LGE CMR between January 2003 and February 2010 within 1 month prior to CABG were included. A standard 16 segment model was used for scar quantification. A score of 1 for no scar, 2 for<50 % and 3 for>50 % transmurality was assigned for each segment. LV scar score (LVSS) defined as the sum of segment scores divided by 16. All-cause mortality was ascertained by social security death index. RESULTS: One hundred ninety-six patients met the inclusion criteria. 185 CMR studies were available. History of prior MI was present in 64 % and prior CABG in 5.4 % of patients. Scar was present in 72 % of patients and median LVEF was 38 %. Over a median follow up of 8.3 years, there were 64 deaths (34.6 %). There was no statistically significant difference in mortality between Scar and No-scar groups (37 % versus 29 %). In the group with scar, a lower scar burden (defined either<4 segments with scar or based on LVSS) was independently associated with increased survival.
English
1097-6647
*Cardiomyopathies/dg [Diagnostic Imaging]
*Cicatrix/dg [Diagnostic Imaging]
*Coronary Artery Bypass
*Coronary Artery Disease/su [Surgery]
*Heart Failure/dg [Diagnostic Imaging]
*Magnetic Resonance Imaging, Cine
*Myocardial Infarction/dg [Diagnostic Imaging]
*Myocardium/pa [Pathology]
Aged
Cardiomyopathies/mo [Mortality]
Cardiomyopathies/pp [Physiopathology]
Cicatrix/mo [Mortality]
Cicatrix/pp [Physiopathology]
Contrast Media/ad [Administration & Dosage]
Coronary Artery Bypass/ae [Adverse Effects]
Coronary Artery Bypass/mo [Mortality]
Coronary Artery Disease/dg [Diagnostic Imaging]
Coronary Artery Disease/mo [Mortality]
Databases, Factual
Female
Heart Failure/mo [Mortality]
Heart Failure/pp [Physiopathology]
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction/mo [Mortality]
Myocardial Infarction/pp [Physiopathology]
Predictive Value of Tests
Proportional Hazards Models
Recovery of Function
Retrospective Studies
Risk Factors
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
MedStar Health Research Institute
MedStar Heart & Vascular Institute
MedStar Washington Hospital Center
Medicine
Journal Article