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

Cleland, John G. F.; Bourantas, Christos V.; Cleland, John G F; Clark, Andrew L.; Alamgir, Mohamed F.; Tweddel, Ann C.; Lukaschuk, Elena I.; Loh, Huan P.; Nikitin, Nikolay P.; Bourantas, Christos V; Nikitin, Nikolay P; Loh, Huan P; Lukaschuk, Elena I; Sherwi, Nassar; de Silva, Ramesh; Tweddel, Ann C; Alamgir, Mohamed F; Wong, Kenneth; Gupta, Sanjay; Clark, Andrew L; Cleland, John GF

Authors

John G. F. Cleland

Christos V. Bourantas

John G F Cleland

Andrew L. Clark

Mohamed F. Alamgir

Ann C. Tweddel

Elena I. Lukaschuk

Huan P. Loh

Nikolay P. Nikitin

Christos V Bourantas

Nikolay P Nikitin

Huan P Loh

Elena I Lukaschuk

Nassar Sherwi

Ramesh de Silva

Ann C Tweddel

Mohamed F Alamgir

Kenneth Wong

Sanjay Gupta

Andrew L Clark A.L.Clark@hull.ac.uk

John GF Cleland



Abstract

BackgroundCardiovascular 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. MethodsWe 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. ResultsThe 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. ConclusionsIn 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.

Journal Article Type Article
Publication Date Sep 21, 2011
Journal JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE
Print ISSN 1097-6647
Electronic ISSN 1532-429X
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 13
Issue 53
Article Number ARTN 53
APA6 Citation Bourantas, C. V., Nikitin, N. P., Loh, H. P., Lukaschuk, E. I., Sherwi, N., de Silva, R., …Cleland, J. G. (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 : official journal of the Society for Cardiovascular Magnetic Resonance, 13(53), doi:10.1186/1532-429x-13-53. ISSN 1097-6647
DOI https://doi.org/10.1186/1532-429x-13-53
Keywords Heart failure; Myocardial infarction; Hibernation; Cardiovascular magnetic resonance imaging; Late gadolinium enhancement
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