Prognostic Value of Routine Cardiac Magnetic Resonance Assessment of Left Ventricular Ejection Fraction and Myocardial Damage: An International, Multicenter Study

OBJECTIVES: Cardiac Magnetic Resonance (CMR) is considered the reference standard for assessment of left ventricular ejection fraction (LVEF) and myocardial damage. However, few studies have evaluated the relationship between CMR findings and patient outcome, and of these most are small and none are multicenter. We performed an international, multicenter study to assess the prognostic importance of routine CMR in patients with known or suspected heart disease.

METHODS: Consecutive patients from 10 centers in 6 countries undergoing routine CMR assessment of LVEF and myocardial damage by cine and delayed-enhancement imaging (DE-CMR), respectively, were screened for enrollment. Clinical data, CMR protocol information and findings were collected at all sites and submitted to the data-coordinating center for verification of completeness and analysis. The primary endpoint was all-cause mortality.

RESULTS: A total of 1560 patients (59±14 years; 70% male) were enrolled. Mean LVEF was 45±18% and 1049 patients (67%) had hyperenhanced tissue (HE) on DE-CMR indicative of damage. During a median follow-up time of 2.4 years (IQR 1.2, 2.9 years), 176 patients (11.3%) died. Patients who died were more likely to be older (p4 segments) had reduced survival compared to patients with ≤ median HE (p=0.02).

CONCLUSIONS: Both LVEF and amount of myocardial damage as assessed by routine CMR are independent predictors of all-cause mortality. Even in patients with near normal LVEF, significant damage identifies a cohort with high-risk for early mortality. Markus Wheaton Womens Jersey

PMID:

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One Comment

  1. Very large multi-center cohort of CAD patients recruited from 1999 to 2004.
    The most commonly used pulse sequence for DE-CMR was the 2-D segmented inversion-recovery GRE sequence, which was used in 92% studies. It would be interesting to know how these large academic centers have evolved and how often do they now use 3-D segmented or other sequences.
    The addition of segments with persistent delayed enhancement resulted in further significant improvement in the model for predicting all-cause mortality, even more than LVEF.
    Additionally, the distribution of areas with irreversible damage may be interesting to know as well. Is the worse prognosis due to infarct size or to the relation between myocardial scar and other functional parameters such as diastolic dysfunction?

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