scholarly journals 1002 Women with severe ischemic cardiomyopathy have worse survival than men despite similar degree of myocardial scar: a delayed hyper-enhancement MRI study

2008 ◽  
Vol 10 (S1) ◽  
Author(s):  
Deborah H Kwon ◽  
Carmel M Halley ◽  
Thomas P Carrigan ◽  
Victoria Zysek ◽  
Randall Setser ◽  
...  
Keyword(s):  
Ischemic Cardiomyopathy ◽  
Myocardial Scar ◽  
Similar Degree ◽  
Mri Study

scholarly journals ECG Quantification of Myocardial Scar Cannot Predict Future Cardiac Events in Patients with Non-Ischemic Cardiomyopathy

2011 ◽  
Vol 27 (Supplement) ◽  
pp. OP46_3
Author(s):  
Il-Young Oh ◽  
Min-Ho Lee ◽  
Do-Yun Kang ◽  
Eue-Keun Choi ◽  
Tae-Jin Youn ◽  
...  
Keyword(s):  
Ischemic Cardiomyopathy ◽  
Myocardial Scar ◽  
Cardiac Events

Abstract 2419: The Presence of Q Waves, QRS Fragmentation or QRS Duration Does Not Correlate with Scar Volume in Patients with Ischemic Cardiomyopathy.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Mary G Carey ◽  
Andrew J Luisi ◽  
Sunil Baldwa ◽  
Joshua M Thomas ◽  
John M Canty ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Ejection Fraction ◽  
Ischemic Cardiomyopathy ◽  
Infarct Volume ◽  
Myocardial Scar ◽  
Poor Correlation ◽  
S Waves ◽  
Volume Table ◽  
Wide Range ◽  
Qrs Duration

Background. Recent studies have suggested that scar volume is one of the predictors of ICD utilization. We hypothesized that noninvasive ECG predictors of myocardial scar (number of leads with Q waves and/or fragmented QRS complexes, fQRS) would correlate with infarct size and could predict patients with a depressed ejection fraction that would be the most likely to benefit from imaging scar volume. Methods. Patients with ischemic cardiomyopathy eligible for an ICD for the primary prevention of sudden death underwent PET imaging (n=78). Scar volume (% LV) was quantified from 18 FDG uptake during insulin stimulation and 13 N-ammonia flow using a validated algorithm (MyoPC, Ottawa Heart Institute). Pathologic Q waves and fQRS (RSR morphology or notching in R or S waves) on the 12-lead ECG were assessed by consensus of three blinded readers. Results. Subjects were 67 ± 12 years of age and 87% male. Average ejection fraction was 28 ± 10%. Myocardial scar encompassed 17.1 ± 7.3% of the left ventricle, with a very wide range among subjects (1.9 to 34.4%). In patients with a QRS duration <120 msec (n=47), there was very poor correlation between scar volume and the number of leads with Q waves, fQRS or both (R 2 =0.01– 0.06, Table ). Furthermore, patients with a wide QRS (>120 msec) did not have an increase in scar volume (Table ). Conclusions. These results indicate that 1.) The volume of scar varies widely in patients with ischemic cardiomyopathy that are eligible to receive an ICD for primary prevention and 2.) Infarct volume is independent of electrocardiographic indices of scar. Thus, imaging is necessary to stratify risk for SCD as a function of scar volume.

Abstract 3098: Left Ventricular Delayed Hyper-enhancement Further Risk Stratifies Patients with Severe Systolic Dysfunction Regardless of the Presence of Coronary Artery Disease: A Cardiac MRI Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Deborah H Kwon ◽  
Carmel Halley ◽  
Tom Carrigan ◽  
Randolph Setser ◽  
Paul Schoenhagen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Systolic Dysfunction ◽  
Characteristic Curve ◽  
Left Ventricular ◽  
Myocardial Scar ◽  
Scar Burden ◽  
Lv Dysfunction ◽  
Artery Disease ◽  
Mri Study

Background: Patients with severe systolic left ventricular (LV) dysfunction have poor survival. Delayed hyperenhancement magnetic resonance imaging (DHE-MRI) accurately measures myocardial scar. In patients with severe systolic LV dysfunction, it is unclear if presence of scar further impacts survival. We sought to determine if presence of LV scar further risk-stratifies patients with severe LV dysfunction. Methods: We studied 199 consecutive patients with LV systolic dysfunction who underwent DHE-MRI (Siemens 1.5 T scanner, Erlangen, Germany) from 2005– 6. The percentage of myocardial scar was determined semi-quantitatively on DHE-MR images, in a standard 17-segment model using custom software (Siemens Research), and defined as intensity >2 standard deviation above viable myocardium. Transmurality score was recorded in all segments as follows: 0 = no scar, 1 = 1–25% scar, 2 = 26 –50 %, 3 = 51–75% and 4 = > 75%. Global LV scar burden was calculated as total transmurality score for all segments/17. LV ejection fraction (EF) and end-diastolic diameter (EDD) were recorded from echocardiography. Presence of coronary artery disease (CAD) and all-cause mortality were recorded. Results: In a median follow up of 1.6 years [1, 1.9], 26 (13 %) patients died. Characteristics of survivors vs. non-survivors are detailed in Table . Survival in patients with any amount of LV scar had significantly worse 1-year survival compared to those without (log-rank p = 0.03). Median global LV scar burden was 1.8 [1, 2.5]. On receiver operating characteristic curve analysis, global scar burden > 1.8 was predictive of death (area under curve 0.61, p = 0.05). Patients with scar burden > 1.8 also had significantly worse 1-year survival compared to those with scar burden ≤ 1.8 (log rank p = 0.03). Conclusions: In patients with severe systolic LV dysfunction, higher LV myocardial scar burden, detected on DHE-MRI is associated with worse survival, despite similar LVEF, LVEDD, and prevalence of CAD. Table

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