PMID- 18725488
OWN - NLM
STAT- MEDLINE
DCOM- 20080923
LR  - 20211020
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 118
IP  - 10
DP  - 2008 Sep 2
TI  - Incidence and prognostic implication of unrecognized myocardial scar 
      characterized by cardiac magnetic resonance in diabetic patients without clinical 
      evidence of myocardial infarction.
PG  - 1011-20
LID - 10.1161/CIRCULATIONAHA.107.727826 [doi]
AB  - BACKGROUND: Silent myocardial infarctions (MIs) are prevalent among diabetic 
      patients and inflict significant morbidity and mortality. Although late 
      gadolinium enhancement (LGE) imaging by cardiac magnetic resonance (CMR) can 
      provide sensitive characterization of myocardial scar, its prognostic 
      significance in diabetic patients without any clinical evidence of MI is unknown. 
      METHODS AND RESULTS: We performed clinically indicated CMR imaging in 187 
      diabetic patients who were 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). CMR imaging and follow-up were successful in 107 study 
      patients (98%) and 74 control patients (95%). Cox regression analyses were 
      performed to associate LGE with major adverse cardiovascular events (MACE), 
      including death, acute MI, new congestive heart failure or unstable angina, 
      stroke, and significant ventricular arrhythmias. LGE by CMR was present in 30 of 
      107 study patients (28%). At a median follow-up of 17 months, 38 of 107 patients 
      (36%) experienced MACE, which included 18 deaths. Presence of LGE was associated 
      with a >3-fold hazards increase for MACE and for death (hazard ratio, 3.71 and 
      3.61; P<0.001 and P=0.007, respectively). Adjusted to a model that combines 
      patient age, sex, ST or T changes on ECG, and left ventricular end-systolic 
      volume index, LGE maintained a >4-fold hazards increase for MACE (adjusted hazard 
      ratio, 4.13; 95% confidence interval, 1.74 to 9.79; P=0.001). In addition, LGE 
      provided significant prognostic value with MACE and with death adjusted to a 
      diabetic-specific risk model for 5-year events. The presence of LGE was the 
      strongest multivariable predictor of MACE and death by stepwise selection in the 
      study patients. CONCLUSIONS: CMR imaging can characterize occult myocardial scar 
      consistent with MI in diabetic patients without clinical evidence of MI. This 
      imaging finding demonstrates strong association with MACE and mortality hazards 
      that is incremental to clinical, ECG, and left ventricular function combined.
FAU - Kwong, Raymond Y
AU  - Kwong RY
AD  - MPH, Cardiovascular Division, Department of Medicine, Brigham and Women's 
      Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA. 
      rykwong@partners.org
FAU - Sattar, Hamid
AU  - Sattar H
FAU - Wu, Henry
AU  - Wu H
FAU - Vorobiof, Gabriel
AU  - Vorobiof G
FAU - Gandla, Vijay
AU  - Gandla V
FAU - Steel, Kevin
AU  - Steel K
FAU - Siu, Samuel
AU  - Siu S
FAU - Brown, Kenneth A
AU  - Brown KA
LA  - eng
GR  - R01 HL091157/HL/NHLBI NIH HHS/United States
GR  - R01 HL091157-01/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20080825
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
CIN - Curr Cardiol Rep. 2009 Jan;11(1):45-6. PMID: 19091174
MH  - Aged
MH  - Cicatrix/*diagnostic imaging/etiology/mortality
MH  - Diabetes Complications/*diagnostic imaging/mortality
MH  - Female
MH  - Follow-Up Studies
MH  - Gadolinium/pharmacology
MH  - Humans
MH  - Incidence
MH  - *Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/etiology/mortality
MH  - Prevalence
MH  - Radiography
MH  - *Ventricular Function, Left
PMC - PMC2743310
MID - NIHMS126424
COIS- Conflict of Interest Disclosures: None
EDAT- 2008/08/30 09:00
MHDA- 2008/09/24 09:00
PMCR- 2009/09/14
CRDT- 2008/08/30 09:00
PHST- 2008/08/30 09:00 [pubmed]
PHST- 2008/09/24 09:00 [medline]
PHST- 2008/08/30 09:00 [entrez]
PHST- 2009/09/14 00:00 [pmc-release]
AID - CIRCULATIONAHA.107.727826 [pii]
AID - 10.1161/CIRCULATIONAHA.107.727826 [doi]
PST - ppublish
SO  - Circulation. 2008 Sep 2;118(10):1011-20. doi: 10.1161/CIRCULATIONAHA.107.727826. 
      Epub 2008 Aug 25.