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August 25, 2008CirculationOpen Access

Incidence and Prognostic Implication of Unrecognized Myocardial Scar Characterized by Cardiac Magnetic Resonance in Diabetic Patients Without Clinical Evidence of Myocardial Infarction

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Key result

Unrecognized myocardial scar by CMR in diabetic patients without clinical MI was associated with a significantly increased risk of MACE (adjusted HR 4.13; 95% CI 1.74-9.79; P=0.001).

Why the study?

Does the presence of unrecognized myocardial scar characterized by CMR LGE predict MACE and mortality in diabetic patients without clinical evidence of MI?

Population

187 diabetic patients, grouped by the absence or presence of clinical evidence of MI. 107 study patients and…

Comparison

Presence of late gadolinium enhancement on… vs Absence of late gadolinium enhancement on CMR…

Design

Cohort

Follow-up

median 17 months

Authors

RKRaymond Y. KwongCardiac ImagingHSHamid SattarWayne State UniversityHWHenry WuIcahn School of Medicine at Mount Sinai

Discussion

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Implication

May support CMR for risk stratification in diabetes; hypothesis-generating and requires prospective validation before practice change.

Key Points

  • To determine the prevalence and long-term prognostic significance of unrecognized myocardial scar detected by cardiac magnetic resonance in diabetic patients without clinical evidence of myocardial infarction.
  • Evaluated 187 diabetic patients undergoing clinically indicated cardiac magnetic resonance (CMR), separated into those without clinical evidence of myocardial infarction (study group, n=109) and those with prior MI (control group, n=78).
  • Assessed myocardial scar using late gadolinium enhancement (LGE) CMR imaging and followed 107 study patients over a median duration of 17 months for major adverse cardiovascular events (MACE) and all-cause mortality.
  • Unrecognized myocardial scar by LGE was identified in 28% (30/107) of diabetic patients without prior clinical evidence of MI.
  • During follow-up, 36% (38/107) of patients experienced MACE, with LGE presence conferring an unadjusted hazard ratio of 3.71 (P<0.001) for MACE and 3.61 (P=0.007) for mortality.
  • In multivariable analysis adjusting for age, sex, ECG abnormalities, and left ventricular end-systolic volume index, LGE remained the strongest independent predictor of MACE (adjusted HR 4.13; 95% CI, 1.74 to 9.79; P=0.001).

Study Design

Type

Cohort (n=187)

Structured PICO

Does the presence of unrecognized myocardial scar characterized by CMR LGE predict MACE and mortality in diabetic patients without clinical evidence of MI?

P
Population
187 diabetic patients, grouped by the absence (study group, n=109) or presence (control group, n=78) of clinical evidence of MI (clinical history of MI or Q waves on ECG). 107 study patients and 74 control patients had successful CMR and follow-up.
I
Intervention
Presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging indicating unrecognized myocardial scar
C
Comparator
Absence of late gadolinium enhancement (LGE) on CMR imaging
O
Outcome
Major adverse cardiovascular events (MACE), including death, acute MI, new congestive heart failure or unstable angina, stroke, and significant ventricular arrhythmiascomposite

Main Result

Effect estimate: adjusted HR 4.13 (95% CI 1.74-9.79)

p-value: p=0.001

Unrecognized myocardial scar detected by CMR LGE is a strong, independent predictor of MACE and mortality in diabetic patients without clinical evidence of prior MI.

Cite This Study

Kwong et al. (2008) conducted a cohort in Diabetes mellitus without clinical evidence of myocardial infarction (n=187). Late gadolinium enhancement (LGE) by CMR vs. Absence of LGE was evaluated on Major adverse cardiovascular events (MACE) (adjusted HR 4.13, 95% CI 1.74-9.79, p=0.001). Unrecognized myocardial scar by CMR in diabetic patients without clinical MI was associated with a significantly increased risk of MACE (adjusted HR 4.13; 95% CI 1.74-9.79; P=0.001).

synapsesocial.com/papers/6a1205ab1dce72a77db4c4b6https://doi.org/10.1161/circulationaha.107.727826
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Also Consider

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