Prevalence of scarred and dysfunctional myocardium in patients with heart failure of ischaemic origin: A cardiovascular magnetic resonance study

Bourantas, C. V. et al. (2011) Prevalence of scarred and dysfunctional myocardium in patients with heart failure of ischaemic origin: A cardiovascular magnetic resonance study. Journal of Cardiovascular Magnetic Resonance, 13(1), 53. (doi: 10.1186/1532-429X-13-53) (PMID:21936915) (PMCID:PMC3190338)

Abstract

Background: Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) can provide unique data on the transmural extent of scar/viability. We assessed the prevalence of dysfunctional myocardium, including partial thickness scar, which could contribute to left ventricular contractile dysfunction in patients with heart failure and ischaemic heart disease who denied angina symptoms. Methods: We invited patients with ischaemic heart disease and a left ventricular ejection fraction < 50% by echocardiography to have LGE CMR. Myocardial contractility and transmural extent of scar were assessed using a 17-segment model. Results: The median age of the 193 patients enrolled was 70 (interquartile range: 63-76) years and 167 (87%) were men. Of 3281 myocardial segments assessed, 1759 (54%) were dysfunctional, of which 581 (33%) showed no scar, 623 (35%) had scar affecting ≤50% of wall thickness and 555 (32%) had scar affecting > 50% of wall thickness. Of 1522 segments with normal contractile function, only 98 (6%) had evidence of scar on CMR. Overall, 182 (94%) patients had ≥1 and 107 (55%) patients had ≥5 segments with contractile dysfunction that had no scar or ≤50% transmural scar suggesting viability. Conclusions: In this cohort of patients with left ventricular systolic dysfunction and ischaemic heart disease, about half of all segments had contractile dysfunction but only one third of these had > 50% of the wall thickness affected by scar, suggesting that most dysfunctional segments could improve in response to an appropriate intervention.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Bourantas, C. V., Nikitin, N. P., Loh, H. P., Lukaschuk, E. I., Sherwi, N., de Silva, R., Tweddel, A. C., Alamgir, M. F., Wong, K., Gupta, S., Clark, A. L., and Cleland, J. G.F.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Journal of Cardiovascular Magnetic Resonance
• Publisher: BioMed Central
• ISSN: 1097-6647
• ISSN (Online): 1532-429X
• Published Online: 21 September 2011
• Copyright Holders: Copyright © 2011 Bourantas et al; licensee BioMed Central Ltd.
• First Published: First published in Journal of Cardiovascular Magnetic Resonance 13:53
• Publisher Policy: Reproduced under a Creative Commons License