Prognostic significance of delayed-enhancement magnetic resonance imaging: survival of 857 patients with and without left ventricular dysfunction.
BACKGROUND
Left ventricular ejection fraction is a powerful independent predictor of survival in cardiac patients, especially those with coronary artery disease. Delayed-enhancement magnetic resonance imaging (DE-MRI) can accurately identify irreversible myocardial injury with high spatial and contrast resolution. To date, relatively limited data are available on the prognostic value of DE-MRI, so we sought to determine whether DE-MRI findings independently predict survival.


RESULTS
The medical records of 857 consecutive patients who had complete cine and DE-MRI evaluation at a tertiary care center were reviewed regardless of whether the patients had coronary artery disease. The presence and extent of myocardial scar were evaluated qualitatively by a single experienced observer. The primary, composite end point was all-cause mortality or cardiac transplantation. Survival data were obtained from the Social Security Death Index. The median follow-up was 4.4 years; 252 patients (29%) reached one of the end points. Independent predictors of mortality or transplantation included congestive heart failure, ejection fraction, and age (P<0.0001 for each), as well as scar index (hazard ratio, 1.26; 95% confidence interval, 1.02 to 1.55; P=0.033). Similarly, in subsets of patients with or without coronary artery disease, scar index also independently predicted mortality or transplantation (hazard ratio, 1.33; 95% confidence interval, 1.05 to 1.68; P=0.018; and hazard ratio, 5.65; 95% confidence interval, 1.74 to 18.3; P=0.004, respectively). Cox regression analysis showed worse outcome in patients with any DE in addition to depressed left ventricular ejection fraction (<50%).


CONCLUSIONS
The degree of DE detected by DE-MRI appears to strongly predict all-cause mortality or cardiac transplantation after adjustment for traditional, well-known prognosticators.
Cheong
Benjamin Y C
BY
Department of Diagnostic and Interventional Radiology, St. Luke's Episcopal Hospital and the Texas Heart Institute, 6720 Bertner Ave, MC 2-270, Houston, TX 77030, USA. bcheong@sleh.com
Muthupillai
Raja
R
Wilson
James M
JM
Sung
Angela
A
Huber
Steffen
S
Amin
Samir
S
Elayda
MacArthur A
MA
Lee
Vei-Vei
VV
Flamm
Scott D
SD
D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000401:mortality; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality*