title: Prevalence of scarred and dysfunctional myocardium in patients with heart failure of ischaemic origin: a cardiovascular magnetic resonance study.
abstract: BACKGROUND
  Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) can provide unique data on the transmural extent of scar/viability. We assessed the prevalence of dysfunctional myocardium, including partial thickness scar, which could contribute to left ventricular contractile dysfunction in patients with heart failure and ischaemic heart disease who denied angina symptoms.
  
  
  METHODS
  We invited patients with ischaemic heart disease and a left ventricular ejection fraction < 50% by echocardiography to have LGE CMR. Myocardial contractility and transmural extent of scar were assessed using a 17-segment model.
  
  
  RESULTS
  The median age of the 193 patients enrolled was 70 (interquartile range: 63-76) years and 167 (87%) were men. Of 3281 myocardial segments assessed, 1759 (54%) were dysfunctional, of which 581 (33%) showed no scar, 623 (35%) had scar affecting ≤50% of wall thickness and 555 (32%) had scar affecting > 50% of wall thickness. Of 1522 segments with normal contractile function, only 98 (6%) had evidence of scar on CMR. Overall, 182 (94%) patients had ≥1 and 107 (55%) patients had ≥5 segments with contractile dysfunction that had no scar or ≤50% transmural scar suggesting viability.
  
  
  CONCLUSIONS
  In this cohort of patients with left ventricular systolic dysfunction and ischaemic heart disease, about half of all segments had contractile dysfunction but only one third of these had > 50% of the wall thickness affected by scar, suggesting that most dysfunctional segments could improve in response to an appropriate intervention.
authors.affiliation: Department of Cardiology, Academic Unit, University of Hull, Postgraduate Medical Institute, Kingston-upon-Hull, UK. cbourantas@gmail.com
authors.forename: Christos V
authors.initials: CV
authors.lastname: Bourantas
authors.forename: Nikolay P
authors.initials: NP
authors.lastname: Nikitin
authors.forename: Huan P
authors.initials: HP
authors.lastname: Loh
authors.forename: Elena I
authors.initials: EI
authors.lastname: Lukaschuk
authors.forename: Nassar
authors.initials: N
authors.lastname: Sherwi
authors.forename: Ramesh
authors.initials: R
authors.lastname: de Silva
authors.forename: Ann C
authors.initials: AC
authors.lastname: Tweddel
authors.forename: Mohamed F
authors.initials: MF
authors.lastname: Alamgir
authors.forename: Kenneth
authors.initials: K
authors.lastname: Wong
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: John Gf
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000368:Aged; D002921:Cicatrix / Q000175:diagnosis / Q000209:etiology; D003287:Contrast Media; D004452:Echocardiography; D004739:England; D005260:Female; D019786:Gadolinium DTPA; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D016014:Linear Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000150:complications*; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D013318:Stroke Volume; D014022:Tissue Survival; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA