Nonstress delayed-enhancement magnetic resonance imaging of the myocardium predicts improvement of function after revascularization for chronic ischemic heart disease with left ventricular dysfunction
| Autor: | Nancy A. Obuchowski, Richard D. White, Paulo R. Schvartzman, Jane M. Kasper, Monvadi B. Srichai, Patrick M. McCarthy, Richard A. Grimm, Donald F. Hammer |
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| Rok vydání: | 2003 |
| Předmět: |
Adult
Male medicine.medical_specialty Heart disease medicine.medical_treatment Ischemia Myocardial Ischemia Revascularization Cicatrix Ventricular Dysfunction Left Internal medicine Myocardial scarring Myocardial Revascularization Medicine Humans Coronary Artery Bypass Aged Ejection fraction medicine.diagnostic_test business.industry Magnetic resonance imaging Middle Aged medicine.disease Magnetic Resonance Imaging Myocardial Contraction medicine.anatomical_structure Ventricle Echocardiography Cardiology Regression Analysis Female medicine.symptom Cardiology and Cardiovascular Medicine business Cardiomyopathies Artery |
| Zdroj: | American heart journal. 146(3) |
| ISSN: | 1097-6744 |
| Popis: | Background The extent of myocardial scarring of the left ventricle (LV) is important in patients with chronic ischemic heart disease (CIHD). With delayed-enhancement magnetic resonance imaging (DE-MRI), scarred myocardium (hyper-enhanced) is easily distinguishable from viable (dark) myocardium. This investigation assessed the use of DE-MRI for predicting functional improvement after coronary artery bypass grafting (CABG) in patients with CIHD and significant LV dysfunction. Methods The patient population (n = 29) with CIHD and LV dysfunction (ejection fraction 28% ± 10%) underwent both DE-MRI, to delineate scarred regions before revascularization, and echocardiography (Echo), to assess segmental function before and after CABG (interval 188 ± 57 days). Using a 16-segment model, LV myocardium was semiquantitatively analyzed for scarring based on DE-MRI and for improvements in resting function by pre- and post-CABG Echo. Results Before CABG, 82% of targeted myocardial segments had abnormal contraction; 78% showed scarring, including 38% with greater than mild amounts (25%–100%). Normal contraction was found in 18% of segments before revascularization; scarred areas were identified in 42%, 84% of which had, at most, minimal amounts (0%–24%). Of segments with pre-CABG dysfunction, 82% with no evidence of scar recovered, compared to only 18% with ≥50% scarring. Amount of hyper-enhancement was a very good indicator of improvement of function, especially at the ≥50%/segment threshold; overall accuracy was 0.74 (95% CI 0.66–0.82, P Conclusions In patients with CIHD and significant LV dysfunction, DE-MRI can predict likelihood of functional improvement after revascularization. |
| Databáze: | OpenAIRE |
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