Late gadolinium enhancement by cardiovascular magnetic resonance is complementary to left ventricle ejection fraction in predicting prognosis of patients with stable coronary artery disease

Journal of Cardiovascular Magnetic Resonance

Research

Paola Baiardi¹  Monica Ceresa²  Oronzo Catalano²  Mariarosa Perotti²  Silvia G Priori³  Serena Antonaci⁴  Mauro Frascaroli⁵  Maurizia Baldi⁵  Guido Moro⁵  Carlo Napolitano⁶ 

[1] Direzione Scientifica Centrale, IRCCS Fondazione Salvatore Maugeri, via Maugeri 6, Pavia, Italy;Divisione di Cardiologia, IRCCS Fondazione Salvatore Maugeri, via Maugeri 6, Pavia, Italy;Divisione di Cardiologia, IRCCS Fondazione Salvatore Maugeri, via Maugeri 6, Pavia, Italy;Dipartimento di Cardiologia, Università of Pavia, Pavia, Italy;Divisione di Cardiologia, Presidio Ospedaliero Sacro Cuore, Gallipoli, Italy;Servizio di Diagnostica per Immagini, IRCCS Fondazione Salvatore Maugeri, via Maugeri 6, Pavia, Italy;Unità di Cardiologia Molecolare, IRCCS Fondazione Salvatore Maugeri, via Maugeri 6, Pavia, Italy;The Leon Charney Division of Cardiology, New York University School of Medicine, New York, USA;

关键词: Cardiovascular Magnetic Resonance;    Cardiac Resynchronization Therapy;    Late Gadolinium Enhancement;    Stable Coronary Artery Disease;    Left Ventricle Ejection Fraction;   

DOI  :  10.1186/1532-429X-14-29

 received in 2011-10-18, accepted in 2012-05-19,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundLate gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) predicts adverse prognosis in patients with stable coronary artery disease (CAD). However, the interaction with conventional risk factors remains uncertain. Our aim was to assess whether the extent of LGE is an independent predictor of adverse cardiac outcome beyond conventional risk factors, including left ventricle ejection fraction (LVEF).MethodsWe enrolled 376 patients (88% males, 64 ± 11 years) with stable CAD, who underwent LGE assessment and a detailed conventional evaluation (clinical and pharmacological history, risk factors, ECG, Echocardiography). During a follow-up of 38 ± 21 months, 56 events occurred (32 deaths, 24 hospitalizations for heart failure).ResultsLGE and LVEF showed the strongest univariate associations with end-points (HR: 13.61 [95%C.I.: 7.32-25.31] for LGE ≥ 45% of LV mass; and 12.34 [6.80-22.38] for LVEF ≤ 30%; p < 0.0001). Multivariate analysis identified baseline LVEF, loop diuretic therapy, moderate-severe mitral regurgitation and pulmonary hypertension as significant predictors among conventional risk factors. According to a step-wise approach, LGE showed strong association with prognosis as well (5.25 [2.64-10.43]; p < 0.0001). LGE significantly improved the model predictability (chi-square 239 vs 221, F-test p < 0.0001) with an additive effect on the prognostic power of LVEF, which however retained its prognostic power (4.89 [2.50-09.56]; p < 0.0001). Patients with LGE ≥ 45% and/or LVEF ≤ 30% had much worse prognosis compared to patients without risk factors (annual event rates of 43% vs 3%; p < 0.0001). Interestingly LGE was a significant predictor when all cause mortality was analyzed as the only endpoint.ConclusionsThis study demonstrates that LGE assessed by CMR is a robust independent non-invasive marker of prognosis in stable CAD patients. LGE can integrate the available metrics to substantially improve risk stratification.

【 授权许可】

CC BY   
© Catalano et al.; licensee BioMed Central Ltd. 2012