Prediction of global left ventricular functional recovery in patients with heart failure undergoing surgical revascularisation, based on late gadolinium enhancement cardiovascular magnetic resonance.

Abstract

BACKGROUND:

The new gold standard for myocardial viability assessment is late gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR); this technique has demonstrated that the transmural extent of scar predicts segmental functional recovery. We now asked how the number of viable and number of viable+normal, segments predicted recovery of global left ventricular (LV) function in patients undergoing CABG. Finally, we examined which segmental transmural threshold of scarring best predicted global LV recovery.

METHODS AND RESULTS:

Fifty patients with reduced LV ejection fraction (EF) referred for CABG were recruited, and 33 included in this analysis. Patients underwent CMR to assess LV function and viability pre-operatively at 6 days and 6 months. Mean LVEF 38% ± 11, which improved to 43% ± 12 after surgery. 21/33 patients improved EF by ≥3% (EF before 38% ± 13, after 47% ± 13), 12/33 did not (EF before 39% ± 6, after 37% ± 8). The only independent predictor for global functional recovery after revascularisation was the number of viable+normal segments: Based on a segmental transmural viability cutoff of <50%, ROC analysis demonstrated ≥10 viable+normal segments predicted ≥3% improvement in LVEF with a sensitivity of 95% and specificity of 75% (AUC = 0.9, p < 0.001). Transmural viability cutoffs of <25 and <75% and a cutoff of ≥4 viable segments were less useful predictors of global LV recovery.

CONCLUSIONS:

Based on a 50% transmural viability cutoff, patients with ≥10 viable+normal segments improve global LV function post revascularisation, while patients with fewer such segments do not. LGE-CMR is a simple and powerful tool for identifying which patients with impaired LV function will benefit from CABG.

TRIAL REGISTRATION:

Research Ethics Committee Unique Identifier: NRES:05/Q1603/42. The study is listed on the Current Controlled Trials Registry: ISRCTN41388968.URL: http://www.controlled-trials.com.

• Authors: Tammy J Pegg, Joseph B Selvanayagam, Joslin Jennifer, Jane M Francis, Theodoros D Karamitsos, Erica Dall'Armellina, Karen L Smith, David P Taggart, Stefan Neubauer
• Journal: Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance (J Cardiovasc Magn Reson) Vol. 12 Pg. 56 (Oct 07 2010) ISSN: 1532-429X [Electronic] England
• PMID: 20929540 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Contrast Media
• gadodiamide
• Gadolinium DTPA

Topics

• Aged
• Contrast Media
• Coronary Artery Bypass
• England
• Gadolinium DTPA
• Heart Failure (diagnosis, physiopathology, surgery)
• Humans
• Magnetic Resonance Imaging
• Middle Aged
• Myocardium (pathology)
• Patient Selection
• Predictive Value of Tests
• Randomized Controlled Trials as Topic
• Recovery of Function
• Stroke Volume
• Time Factors
• Treatment Outcome
• Ventricular Function, Left