title: Prognostic value of late gadolinium enhancement in hypertensive patients with known or suspected coronary artery disease.
abstract: To determine the prognosis of a myocardial scar assessed by a late gadolinium enhancement (LGE) technique of cardiac magnetic resonance (CMR) in hypertensive patients with known or suspected coronary artery disease (CAD). Patients with systemic hypertension with known or suspected CAD without a clinical history of myocardial infarction were enrolled. All patients underwent CMR for assessment of cardiac function and LGE. Prognostic data was determined by the occurrence of a hard cardiac endpoint, defined as cardiac death or a non-fatal myocardial infarction, or major adverse cardiac events (MACEs), defined as cardiac death, a non-fatal myocardial infarction, or hospitalization due to heart failure, unstable angina, or life-threatening ventricular arrhythmia. A total of 1,644 patients were enrolled; 48% were males and the mean age was 65 +/- 11 years. The average follow-up time was 863 +/- 559 days. Four hundred fifty-three (28%) patients had LGE. LGE was the strongest and most independent predictor for hard events and MACEs with hazard ratios of 4.77 and 3.38, respectively. Other independent predictors of hard events and MACEs were left ventricular ejection fraction and mass, the use of a beta-blocker, and a history of heart failure. The risk of cardiac events increased as the extent of LGE increased; the hazard ratio was 12.74 for hard events for those with a LGE >20% of the myocardium. LGE is the most important and independent predictor for cardiac events in hypertensive patients with known or suspected CAD.
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand. sirkt@mahidol.ac.th
authors.forename: Rungroj
authors.initials: R
authors.lastname: Krittayaphong
authors.forename: Thananya
authors.initials: T
authors.lastname: Boonyasirinant
authors.forename: Vithaya
authors.initials: V
authors.lastname: Chaithiraphan
authors.forename: Adisak
authors.initials: A
authors.lastname: Maneesai
authors.forename: Pairash
authors.initials: P
authors.lastname: Saiviroonporn
authors.forename: Supaporn
authors.initials: S
authors.lastname: Nakyen
authors.forename: Prajak
authors.initials: P
authors.lastname: Thanapiboonpol
authors.forename: Ahthit
authors.initials: A
authors.lastname: Yindeengam
authors.forename: Suthipol
authors.initials: S
authors.lastname: Udompanturak
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D005260:Female; D005682:Gadolinium; D006331:Heart Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000401:mortality / Q000473:pathology; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D003287:Contrast Media; D005682:Gadolinium