Clinical Significance of Late Enhancement and Regional Wall Remodeling Assessed by 3T Magnetic Resonance Imaging.
BACKGROUND
Clinical follow-up studies comparing left ventricular (LV) function and late gadolinium enhancement (LGE) by high-field 3T cardiac magnetic resonance (CMR) are of general interest due to the increased use of 3T scanners. In this study, the occurrence of LGE and LV regional wall remodeling (RWR) was assessed by 3T CMR in patients undergoing coronary angiography for suspected stable coronary artery disease (CAD).


METHODS
Analysis of myocardial viability by LGE was performed at the segmental level. LVRWR was identified by a significant reduction (≥50%) of the wall thickness. Major adverse cardiovascular events (MACE) were registered during a median follow-up time of 58 (45-62) months.


RESULTS
Of the 87 patients (59 ± 9 years; 13 women) enrolled, nonviable myocardium was detected in 35 (40%) and significant CAD in 69 (79%). Nonviable myocardium was correlated to angiographic significant stenosis or occlusion. LVRWR was significantly related to a higher number of nonviable segments compared to those without LVRWR: ie, 6.0 ± 3.2 segments versus 2.6 ± 1.3; P < 0.001. In the nonviable group, LVEF was significantly reduced (P < 0.001) compared to the viable group: ie, 50 ± 16% versus 61 ± 8%, and LVEF was significantly correlated to the number of nonviable segments (r = -0.66, P < 0.001). The number of nonviable segments by LGE was significantly associated with MACE by an odds ratio of 1.25 (95% CI, 1.05-1.49; P = 0.013).


CONCLUSIONS
The presence of nonviable myocardium as detected by LGE at 3T CMR is associated with angiographically significant CAD, and is associated with the development of LVRWR and reduced LVEF. Assessing the extent of nonviable myocardium by both LGE and LVRWR at the segmental level may therefore contribute to individualized risk stratification and treatment strategies.
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. ; Department of Biomedicine, University of Bergen, Bergen, Norway.
Terje H
TH
Larsen
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Marie
M
Stugaard
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Svein
S
Rotevatn
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. ; Institute of Clinical Sciences, University of Bergen, Bergen, Norway.
Ottar
O
Nygård
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. ; Institute of Clinical Sciences, University of Bergen, Bergen, Norway.
Jan Erik
JE
Nordrehaug
adverse remodeling; ischemic heart disease; left ventricular systolic dysfunction; major adverse cardiovascular events; myocardial infarction; prognosis