Value of scar imaging and inotropic reserve combination for the prediction of segmental and global left ventricular functional recovery after revascularisationReport as inadecuate




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Journal of Cardiovascular Magnetic Resonance

, 13:35

First Online: 25 July 2011Received: 01 March 2011Accepted: 25 July 2011

Abstract

BackgroundThis study sought to prospectively and directly compare three cardiovascular magnetic resonance CMR viability parameters: inotropic reserve IR during low-dose dobutamine LDD administration, late gadolinium enhancement transmurality LGE and thickness of the non-contrast-enhanced myocardial rim surrounding the scar RIM. These parameters were examined to evaluate their value as predictors of segmental left ventricular LV functional recovery in patients with LV systolic dysfunction undergoing surgical or percutaneous revascularisation. The second goal of the study was to determine the optimal LDD-CMR- and LGE-CMR-based predictor of significant ≥ 5% LVEF improvement 6 months after revascularisation.

MethodsIn 46 patients with chronic coronary artery disease CAD 63 ± 10 years of age, LVEF 35 ± 8%, wall motion and the above mentioned CMR parameters were evaluated before revascularisation. Wall motion and LGE were repeatedly assessed 6 months after revascularisation. Logistic regression analysis models were created using 333 dysfunctional segments at rest.

ResultsAn LGE threshold value of 50% LGE50 and a RIM threshold value of 4 mm RIM4 produced the best sensitivities and specificities for predicting segmental recovery. IR was superior to LGE50 for predicting segmental recovery. When the areas under the ROC curves is compared, the combined viability prediction model LGE50 + IR was significantly superior to IR alone in all analysed sets of segments, except the segments with an LGE from 26% to 75% p = 0.08. The RIM4 model was not superior to the LGE50 model. A myocardial segment was considered viable if it had no LGE or had any LGE and produced IR during LDD stimulation. ROC analysis demonstrated that ≥ 50% of viable segments from all dysfunctional and revascularised segments in a patient predict significant improvement in LVEF with a 69% sensitivity and 70% specificity AUC 0.7, p = 0.05. The cut-off of ≥ 3 viable segments was a less useful predictor of significant global LV recovery.

ConclusionsLDD-CMR is superior to LGE-CMR as a predictor of segmental recovery. The advantage is greatest in the segments with an LGE from 26% to 75%. The RIM cut-off value of 4 mm had no superiority over the LGE cut-off value of 50% in predicting the segmental recovery. Patients with ≥ 50% of viable segments from all dysfunctional and revascularised had a tendency to improve LVEF by ≥ 5% after revascularisation.

List of abbreviationsACEangiotensin-converting enzyme

AUCarea under the curve

BSAbody surface area

CABGcoronary artery bypass graft surgery

CCSCanadian Cardiovascular Society

CMRcardiovascular magnetic resonance

EFejection fraction

GFRglomerular filtration rate

IRinotropic reserve

LADleft anterior descending artery

LDDlow-dose dobutamine

LIMAleft internal mammary artery

LGElate gadolinium enhancement

LVleft ventricle

MImyocardial infarction

NPVnegative predictive value

NYHANew York Heart Association

ONBEATon-pump beating heart coronary artery bypass graft surgery

ONSTOPconventional cardioplegic arrest coronary artery bypass graft surgery

PCIpercutaneous coronary intervention

PPVpositive predictive value

RIMthickness of the non-contrast-enhanced myocardial rim surrounding the scar

ROCreceiver operating curve

SPECTsingle-photon-emission computed tomography

SSFPsteady-state free precession sequence

WMSIwall motion score index

Electronic supplementary materialThe online version of this article doi:10.1186-1532-429X-13-35 contains supplementary material, which is available to authorized users.

Sigita Glaveckaite, Nomeda Valeviciene, Darius Palionis contributed equally to this work.

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Author: Sigita Glaveckaite - Nomeda Valeviciene - Darius Palionis - Viktor Skorniakov - Jelena Celutkiene - Algirdas Tamosiunas - Gi

Source: https://link.springer.com/article/10.1186/1532-429X-13-35







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