Key result
LVEDD >58 mm predicts ~24-fold greater cardiac death risk in symptomatic post-MI heart failure.
Why the study?
The study was conducted to identify imaging mortality predictors in patients with prior myocardial infarction, symptomatic heart failure, and reduced left ventricular ejection fraction.
Do imaging features from TTE, SPECT-PET, and CMR predict cardiac death in patients with prior MI, symptomatic HF, and LVEF ≤40%?
Cohort (n=39)
Do imaging features from TTE, SPECT-PET, and CMR predict cardiac death in patients with prior MI, symptomatic HF, and LVEF ≤40%?
Effect estimate: OR 23.6 (95% CI 2.6-217.7)
p-value: p=<0.05
Imaging features including LVEDD, LV global longitudinal strain, and defect scores from CMR and SPECT-PET can predict late mortality in patients with prior MI and symptomatic HFrEF.
May aid risk stratification in post-MI symptomatic HFrEF; hypothesis-generating and requires prospective validation before practice change.
Objectives To find the imaging mortality predictors in patients with previous myocardial infarction (MI), symptomatic heart failure (HF), and reduced left ventricle (LV) ejection fraction (EF). Methods for the study 39 patients were selected prospectively with prior MI, symptomatic HF, and LVEF ≤40%. All patients underwent transthoracic echocardiography (TTE), single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI), 18F-FDG positron emission tomography (FDG PET). 31 patients underwent cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). Patients were divided into two groups: 1 group – cardiac death; 2 group – no cardiac death. Myocardial scars were assessed on a 5-point-scale. Follow-up data was obtained. Results Imaging features disclosed significant difference ( p < 0.05) of defect score (CMR and SPECT-PET), LV end-diastolic diameter (EDD) (TTE), LVEDD index (CMR), LV global longitudinal strain (CMR) and LV global circumferential strain (CMR) between the groups. Predictors of cardiac death were: LVEDD index (TTE) and LV global longitudinal strain. The cut-off values to predict cardiac death were: defect score (CMR) 25 (AUC, 79.5%; OR 1.8, 95% CI 1.2–2.7), SPECT-PET defect score 22 (AUC, 73.9%; OR 0.5, 95% CI 0.3–0.7), LVEDD (TTE) 58 mm (AUC, 88.4%; OR 23.6, 95% CI 2.6–217.7), LVEDDi 30 mm/m 2 (TTE) (AUC, 73.6%; OR 22.0, 95% CI 1.9–251.5), LVEDDi 33.6 mm/m 2 (CMR) (AUC, 73.6%; OR 22.0, 95% CI 1.9–251.5), LV global longitudinal strain −13.4 (AUC, 87.8%; OR 2.1, 95% CI 1.2–3.7) and LV global circumferential strain −16.3 (AUC, 76.1%; OR 1.9, 95% CI 1.2–3.0). Conclusions Imaging features, such as defect score (CMR) >25, SPECT-PET defect score >22, LVEDD (TTE) >58 mm, LVEDDi (TTE) >30 mm/m 2 , LVEDDi (CMR) >33.6 mm/m 2 , LV global longitudinal strain −13.4 and LV global circumferential strain −16.3, may increase sensitivity and specificity of FDG PET and LGE CMR predicting of late mortality.
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Kazakauskaitė et al. (2022) conducted a cohort in previous myocardial infarction and symptomatic heart failure (n=39). Imaging features (TTE, SPECT-PET, FDG PET, CMR) was evaluated on Cardiac death (OR 23.6, 95% CI 2.6-217.7, p=<0.05). Echocardiographic LVEDD >58 mm (OR 23.6; 95% CI 2.6-217.7) and CMR defect score >25 (OR 1.8; 95% CI 1.2-2.7) predicted cardiac death in patients with prior MI and symptomatic heart failure.
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