PMID- 16754804
OWN - NLM
STAT- MEDLINE
DCOM- 20060629
LR  - 20220409
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 113
IP  - 23
DP  - 2006 Jun 13
TI  - Impact of unrecognized myocardial scar detected by cardiac magnetic resonance 
      imaging on event-free survival in patients presenting with signs or symptoms of 
      coronary artery disease.
PG  - 2733-43
AB  - BACKGROUND: Contrast-enhanced cardiac magnetic resonance imaging (CMR) can 
      determine the extent of myocardial scar from infarction (MI). However, the 
      prognostic significance of unrecognized myocardial scar by CMR in patients 
      without a history of MI is unknown. METHODS AND RESULTS: One hundred ninety-five 
      patients without a known prior MI underwent CMR for assessment of left 
      ventricular (LV) function and late gadolinium enhancement (LGE). We assessed the 
      prognostic value of LGE and other CMR variables beyond the strongest clinical 
      predictors and built the best overall models for major adverse cardiac events 
      (MACE) and cardiac mortality. During a median follow-up of 16 months, 31 patients 
      (18%) experienced MACE, including 17 deaths. LGE demonstrated the strongest 
      unadjusted associations with MACE and cardiac mortality (hazard ratios of 8.29 
      and 10.9, respectively; both P<0.0001). Patients in the lowest tertile of 
      LGE-involved myocardium (mean LV mass, 1.4%) experienced a >7-fold increased risk 
      for MACE. By multivariable analyses, LGE was independently associated with MACE 
      beyond the clinical model (P<0.0001) or the clinical model combined with 
      angiographically significant coronary stenosis (P=0.0007), LV ejection fraction 
      (P=0.001), LV end-systolic volume index (P=0.0006), or segmental WMA (P=0.002). 
      LGE remained the strongest predictor selected in the best overall models for MACE 
      and cardiac mortality. CONCLUSIONS: Among patients with a clinical suspicion of 
      coronary artery disease but without a history of MI, LGE involving a small amount 
      of myocardium carries a high cardiac risk. In addition, LGE provides incremental 
      prognostic value to MACE and cardiac mortality beyond common clinical, 
      angiographic, and functional predictors.
FAU - Kwong, Raymond Y
AU  - Kwong RY
AD  - Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 
      Harvard Medical School, 75 Francis St, Boston, Masssachusetts 02115, USA. 
      rykwong@partners.org
FAU - Chan, Anna K
AU  - Chan AK
FAU - Brown, Kenneth A
AU  - Brown KA
FAU - Chan, Carmen W
AU  - Chan CW
FAU - Reynolds, H Glenn
AU  - Reynolds HG
FAU - Tsang, Sui
AU  - Tsang S
FAU - Davis, Roger B
AU  - Davis RB
LA  - eng
PT  - Journal Article
DEP - 20060605
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Contrast Media)
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
EIN - Circulation. 2006 Aug 22;114(8):e365
CIN - Circulation. 2006 Jun 13;113(23):2676-8. PMID: 16769923
CIN - Nat Clin Pract Cardiovasc Med. 2006 Dec;3(12):652-3. PMID: 17122796
MH  - Aged
MH  - Cardiovascular Diseases/mortality
MH  - Cicatrix/*pathology
MH  - Cohort Studies
MH  - Comorbidity
MH  - Contrast Media
MH  - Coronary Disease/*complications
MH  - Death, Sudden, Cardiac/epidemiology
MH  - Disease-Free Survival
MH  - Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Gadolinium
MH  - Humans
MH  - Life Tables
MH  - *Magnetic Resonance Imaging, Cine
MH  - Male
MH  - Middle Aged
MH  - Models, Cardiovascular
MH  - Myocardium/*pathology
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Risk
MH  - Smoking/epidemiology
EDAT- 2006/06/07 09:00
MHDA- 2006/06/30 09:00
CRDT- 2006/06/07 09:00
PHST- 2006/06/07 09:00 [pubmed]
PHST- 2006/06/30 09:00 [medline]
PHST- 2006/06/07 09:00 [entrez]
AID - CIRCULATIONAHA.105.570648 [pii]
AID - 10.1161/CIRCULATIONAHA.105.570648 [doi]
PST - ppublish
SO  - Circulation. 2006 Jun 13;113(23):2733-43. doi: 10.1161/CIRCULATIONAHA.105.570648. 
      Epub 2006 Jun 5.