Prognostic Significance of Delayed-Enhancement Magnetic Resonance Imaging: Survival of 857 Patients With and Without Left Ventricular Dysfunction

Left ventricular ejection fraction is a powerful independent predictor of survival in cardiac patients, especially those with coronary artery disease. Delayed-enhancement magnetic resonance imaging (DE-MRI) can accurately identify irreversible myocardial injury with high spatial and contrast resolut...

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Published in:Circulation (New York, N.Y.) N.Y.), 2009-11, Vol.120 (21), p.2069-2076
Main Authors: CHEONG, Benjamin Y. C, MUTHUPILLAI, Raja, WILSON, James M, SUNG, Angela, HUBER, Steffen, AMIN, Samir, ELAYDA, Macarthur A, LEE, Vei-Vei, FLAMM, Scott D
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Cardiovascular system
Coronary Artery Disease - mortality
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Female
Heart Transplantation
Humans
Image Enhancement
Magnetic Resonance Imaging - methods
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Prognosis
Stroke Volume
Vasodilator agents. Cerebral vasodilators
Ventricular Dysfunction, Left - diagnosis
Ventricular Dysfunction, Left - mortality
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container_issue 21
container_start_page 2069
container_title Circulation (New York, N.Y.)
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creator CHEONG, Benjamin Y. C
MUTHUPILLAI, Raja
WILSON, James M
SUNG, Angela
HUBER, Steffen
AMIN, Samir
ELAYDA, Macarthur A
LEE, Vei-Vei
FLAMM, Scott D
description Left ventricular ejection fraction is a powerful independent predictor of survival in cardiac patients, especially those with coronary artery disease. Delayed-enhancement magnetic resonance imaging (DE-MRI) can accurately identify irreversible myocardial injury with high spatial and contrast resolution. To date, relatively limited data are available on the prognostic value of DE-MRI, so we sought to determine whether DE-MRI findings independently predict survival. The medical records of 857 consecutive patients who had complete cine and DE-MRI evaluation at a tertiary care center were reviewed regardless of whether the patients had coronary artery disease. The presence and extent of myocardial scar were evaluated qualitatively by a single experienced observer. The primary, composite end point was all-cause mortality or cardiac transplantation. Survival data were obtained from the Social Security Death Index. The median follow-up was 4.4 years; 252 patients (29%) reached one of the end points. Independent predictors of mortality or transplantation included congestive heart failure, ejection fraction, and age (P
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C ; MUTHUPILLAI, Raja ; WILSON, James M ; SUNG, Angela ; HUBER, Steffen ; AMIN, Samir ; ELAYDA, Macarthur A ; LEE, Vei-Vei ; FLAMM, Scott D</creator><creatorcontrib>CHEONG, Benjamin Y. C ; MUTHUPILLAI, Raja ; WILSON, James M ; SUNG, Angela ; HUBER, Steffen ; AMIN, Samir ; ELAYDA, Macarthur A ; LEE, Vei-Vei ; FLAMM, Scott D</creatorcontrib><description>Left ventricular ejection fraction is a powerful independent predictor of survival in cardiac patients, especially those with coronary artery disease. Delayed-enhancement magnetic resonance imaging (DE-MRI) can accurately identify irreversible myocardial injury with high spatial and contrast resolution. To date, relatively limited data are available on the prognostic value of DE-MRI, so we sought to determine whether DE-MRI findings independently predict survival. The medical records of 857 consecutive patients who had complete cine and DE-MRI evaluation at a tertiary care center were reviewed regardless of whether the patients had coronary artery disease. The presence and extent of myocardial scar were evaluated qualitatively by a single experienced observer. The primary, composite end point was all-cause mortality or cardiac transplantation. Survival data were obtained from the Social Security Death Index. The median follow-up was 4.4 years; 252 patients (29%) reached one of the end points. Independent predictors of mortality or transplantation included congestive heart failure, ejection fraction, and age (P&lt;0.0001 for each), as well as scar index (hazard ratio, 1.26; 95% confidence interval, 1.02 to 1.55; P=0.033). Similarly, in subsets of patients with or without coronary artery disease, scar index also independently predicted mortality or transplantation (hazard ratio, 1.33; 95% confidence interval, 1.05 to 1.68; P=0.018; and hazard ratio, 5.65; 95% confidence interval, 1.74 to 18.3; P=0.004, respectively). Cox regression analysis showed worse outcome in patients with any DE in addition to depressed left ventricular ejection fraction (&lt;50%). 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Independent predictors of mortality or transplantation included congestive heart failure, ejection fraction, and age (P&lt;0.0001 for each), as well as scar index (hazard ratio, 1.26; 95% confidence interval, 1.02 to 1.55; P=0.033). Similarly, in subsets of patients with or without coronary artery disease, scar index also independently predicted mortality or transplantation (hazard ratio, 1.33; 95% confidence interval, 1.05 to 1.68; P=0.018; and hazard ratio, 5.65; 95% confidence interval, 1.74 to 18.3; P=0.004, respectively). Cox regression analysis showed worse outcome in patients with any DE in addition to depressed left ventricular ejection fraction (&lt;50%). 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ispartof Circulation (New York, N.Y.), 2009-11, Vol.120 (21), p.2069-2076
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source Free E-Journal (出版社公開部分のみ）
subjects Adult
Aged
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Cardiovascular system
Coronary Artery Disease - mortality
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Female
Heart Transplantation
Humans
Image Enhancement
Magnetic Resonance Imaging - methods
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Prognosis
Stroke Volume
Vasodilator agents. Cerebral vasodilators
Ventricular Dysfunction, Left - diagnosis
Ventricular Dysfunction, Left - mortality
title Prognostic Significance of Delayed-Enhancement Magnetic Resonance Imaging: Survival of 857 Patients With and Without Left Ventricular Dysfunction
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