Clinical characteristics and outcomes of patients with severe left ventricular dysfunction undergoing cardiac MRI viability assessment prior to revascularization

被引:6
作者
Doukas, Demetrios [1 ,2 ]
Porcaro, Katerina [1 ,2 ]
Marot, Jessica [2 ,3 ]
Burke, Lucas [4 ]
Joyce, Cara [5 ]
Weaver, Frances [6 ]
Nguyen, James [7 ]
Cao, J. Jane [7 ]
Mathew, Verghese [1 ,2 ]
Heroux, Alain [1 ,2 ]
Syed, Mushabbar A. [1 ,2 ,8 ]
机构
[1] Loyola Univ Chicago, Stritch Sch Med, Div Cardiol, Maywood, IL 60153 USA
[2] Loyola Univ Hlth Syst, Maywood, IL 60153 USA
[3] Loyola Univ Chicago, Stritch Sch Med, Dept Internal Med, Maywood, IL 60153 USA
[4] Univ Toronto, Div Cardiol, St Michaels Hosp, Toronto, ON, Canada
[5] Loyola Univ Chicago, Biostat Collaborat Core, Maywood, IL USA
[6] Ctr Innovat Complex Chron Healthcare, Dept Vet Affairs, Hines, IL USA
[7] SUNY Stony Brook, Heart Ctr, Div Cardiol, St Francis Hosp, Rosyln, NY USA
[8] Loyola Univ Chicago, Stritch Sch Med, Loyola Univ Hlth Syst, Div Cardiol,Dept Med, 2160 S 1st Ave, Maywood, IL 60153 USA
关键词
Viability; Cardiac MRI; Ischemic cardiomyopathy; ENHANCED MAGNETIC-RESONANCE; CORONARY-ARTERY-DISEASE; MYOCARDIAL VIABILITY; ISCHEMIC CARDIOMYOPATHY; SYSTOLIC DYSFUNCTION; BYPASS SURGERY; HEART-FAILURE; SURVIVAL; IMPACT; AGE;
D O I
10.1007/s10554-020-02042-w
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Coronary artery bypass grafting improves survival in patients with ischemic cardiomyopathy, however, these patients are at high risk for morbidity and mortality. The role of viability testing to guide revascularization in these patients is unclear. Cardiac magnetic resonance imaging (CMR) has not been studied adequately in this population despite being considered a reference standard for infarct imaging. We performed a multicenter retrospective analysis of patients (n = 154) with severe left ventricular systolic dysfunction [ejection fraction (EF) < 35%] on CMR who underwent CMR viability assessment prior to consideration for revascularization. Using the AHA16-segment model, percent total myocardial viability was determined depending on the degree of transmural scar thickness. Patients with or without revascularization had similar clinical characteristics and were prescribed similar medical therapy. Overall, 43% of patients (n = 66) experienced an adverse event during the median 3 years follow up. For the composite outcome (death, myocardial infarction, heart failure hospitalization, stroke, ventricular tachycardia) patients receiving revascularization were less likely to experience an adverse event compared to those without revascularization (HR 0.53, 95% CI 0.33-0.86,p = 0.01). Patients with > 50% viability on CMR had a 47% reduction in composite events when undergoing revascularization opposed to medical therapy alone (HR 0.53, p = 0.02) whereas patients with a viability < 50% were 2.7 times more likely to experience an adverse event (p = 0.01). CMR viability assessment may be an important tool in the shared decision-making process when considering revascularization options in patients with severe ischemic cardiomyopathy.
引用
收藏
页码:675 / 684
页数:10
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