Key result
Finding ten or more viable segments on LGE-CMR predicts post-surgical LVEF recovery with ~95% sensitivity.
Why the study?
The ability of the number of viable and viable+normal myocardial segments assessed by LGE-CMR to predict global left ventricular functional recovery after CABG was unclear.
Does the number of viable and normal segments on LGE-CMR predict global left ventricular functional recovery in patients with heart failure undergoing CABG?
Cohort (n=33)
No
Does the number of viable and normal segments on LGE-CMR predict global left ventricular functional recovery in patients with heart failure undergoing CABG?
Effect estimate: AUC 0.90
p-value: p=<0.001
In patients with heart failure undergoing CABG, the presence of ≥10 viable or normal segments on LGE-CMR (using a <50% transmural scar cutoff) strongly predicts global LV functional recovery.
Supports using LGE-CMR to estimate post-CABG functional recovery; leaves open whether this.
BACKGROUND: The new gold standard for myocardial viability assessment is late gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR); this technique has demonstrated that the transmural extent of scar predicts segmental functional recovery. We now asked how the number of viable and number of viable+normal, segments predicted recovery of global left ventricular (LV) function in patients undergoing CABG. Finally, we examined which segmental transmural threshold of scarring best predicted global LV recovery. METHODS AND RESULTS: Fifty patients with reduced LV ejection fraction (EF) referred for CABG were recruited, and 33 included in this analysis. Patients underwent CMR to assess LV function and viability pre-operatively at 6 days and 6 months. Mean LVEF 38% ± 11, which improved to 43% ± 12 after surgery. 21/33 patients improved EF by ≥3% (EF before 38% ± 13, after 47% ± 13), 12/33 did not (EF before 39% ± 6, after 37% ± 8). The only independent predictor for global functional recovery after revascularisation was the number of viable+normal segments: Based on a segmental transmural viability cutoff of <50%, ROC analysis demonstrated ≥10 viable+normal segments predicted ≥3% improvement in LVEF with a sensitivity of 95% and specificity of 75% (AUC = 0.9, p < 0.001). Transmural viability cutoffs of <25 and <75% and a cutoff of ≥4 viable segments were less useful predictors of global LV recovery. CONCLUSIONS: Based on a 50% transmural viability cutoff, patients with ≥10 viable+normal segments improve global LV function post revascularisation, while patients with fewer such segments do not. LGE-CMR is a simple and powerful tool for identifying which patients with impaired LV function will benefit from CABG. TRIAL REGISTRATION: Research Ethics Committee Unique Identifier: NRES:05/Q1603/42. The study is listed on the Current Controlled Trials Registry: ISRCTN41388968.URL: http://www.controlled-trials.com.
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Pegg et al. (2010) conducted a cohort in Heart failure with reduced left ventricular ejection fraction undergoing surgical revascularisation (n=33). ≥10 viable and normal segments on LGE-CMR (<50% transmural scar) vs. <10 viable and normal segments was evaluated on Improvement in global left ventricular ejection fraction by ≥3% at 6 months (AUC 0.90, p=<0.001). The presence of ≥10 viable and normal segments on LGE-CMR predicted a ≥3% improvement in global left ventricular ejection fraction 6 months after surgical revascularization with 95% sensitivity and 75% specificity.
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