The number of myocardial segments with LGE >75% was significantly associated with all-cause mortality or heart failure hospitalization after CABG (HR 1.42; 95% CI 1.10-1.83; p=0.007).
Cohort (n=103)
Does the number of myocardial segments with transmurality of LGE >75% predict the composite of all-cause mortality or hospitalization for congestive heart failure in patients with 3-vessel disease and ischemic cardiomyopathy undergoing CABG?
The extent of transmural scar (>75% LGE) on preoperative CMR is a significant predictor of long-term mortality and heart failure hospitalization in patients with ischemic cardiomyopathy undergoing CABG.
Hazard Ratio: 1.42 (95% CI 1.1–1.83)
p-value: p=0.007
Abstract Background This study was conducted to evaluate whether myocardial viability assessed with cardiac magnetic resonance (CMR) affected long-term clinical outcomes after coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy (ICMP). Methods Preoperative CMR with late gadolinium enhancement (LGE) was performed in 103 patients (64.9 ± 10.1 years, male:female = 82:21) with 3-vessel disease and left ventricular dysfunction (ejection fraction ≤ 0.35). Transmural extent of LGE was evaluated on a 16-segment model, and transmurality was graded on a 5-point scale: grades—0, absence; 1, 1 to 25%; 2, 26 to 50%; 3, 51 to 75%; 4, 76 to 100%. Median follow-up duration was 65.5 months (interquartile range = 27.5–95.3 months). Primary endpoint was the composite of all-cause mortality or hospitalization for congestive heart failure. Results Operative mortality was 1.9%. During the follow-up, all-cause mortality and readmission for congestive heart failure occurred in 29 and 8 patients, respectively. The cumulative incidence of the primary endpoint was 31.3 and 46.8% at 5 and 10 years, respectively. Multivariable analysis demonstrated that the number of segments with LGE grade 4 was a significant risk factor (hazard ratio 1.42, 95% confidence interval 1.10–1.83, p = 0.007) for the primary endpoint among the variables assessed by CMR. Other risk factors included age, dialysis, chronic obstructive pulmonary disease, and EuroSCORE II. Conclusion The number of myocardial segments with transmurality of LGE >75% might be a prognostic factor associated with the composite of all-cause mortality or hospitalization for congestive heart failure after CABG in patients with 3-vessel disease and ICMP.
Sohn et al. (Wed,) conducted a cohort in Ischemic cardiomyopathy with 3-vessel disease and left ventricular dysfunction (n=103). Number of myocardial segments with LGE grade 4 (>75% transmurality) was evaluated on Composite of all-cause mortality or hospitalization for congestive heart failure (HR 1.42, 95% CI 1.10-1.83, p=0.007). The number of myocardial segments with LGE >75% was significantly associated with all-cause mortality or heart failure hospitalization after CABG (HR 1.42; 95% CI 1.10-1.83; p=0.007).
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