PMID- 28834627
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20191120
IS  - 2055-5822 (Electronic)
IS  - 2055-5822 (Linking)
VI  - 1
IP  - 2
DP  - 2014 Dec
TI  - Predictive power of late gadolinium enhancement for myocardial recovery in 
      chronic ischaemic heart failure: a HEART sub-study.
PG  - 146-153
LID - 10.1002/ehf2.12019 [doi]
AB  - BACKGROUND: The amount of myocardial scar measured by late gadolinium enhancement 
      (LGE) cardiovascular magnetic resonance (CMR) imaging predicts regional recovery 
      in wall motion following revascularization. Previous studies have been conducted 
      in patients with a relatively recent myocardial insult and relatively preserved 
      left ventricular (LV) function. In this sub-study of a clinical trial, the 
      predictive value of LGE, and other CMR-derived data, for myocardial recovery in 
      patients with chronic severe ischaemic cardiomyopathy was assessed. METHODS: 
      Twenty-two patients with severe LV impairment of ischaemic origin were enrolled 
      as a sub-study of a trial that randomly assigned patients to revascularization or 
      not in addition to guideline-indicated pharmacological therapy. Patients 
      underwent a CMR study at baseline and 6 months. Scans were qualitatively and 
      quantitatively assessed for wall motion, rest/stress myocardial perfusion, and 
      LGE. RESULTS: The median duration of heart failure was 13 (inter-quartile range 
      5-21) months. Patients had severe LV dilatation [end-diastolic volume (EDV) 
      280 +/- 77 mL] and reduction in LV ejection fraction (LVEF) (29 +/- 10%). The 
      percentage scar burden by LGE was 17 +/- 9%. Patient characteristics of those 
      undergoing revascularization (n = 7) or not (n = 14) were similar. Myocardial 
      perfusion reserve index (MPRI) improved following revascularization (MPRI 1.17 
      vs. 1.57, P < 0.0001) but not following medical therapy (1.39 vs. 1.32, 
      P = 0.54). However, LVEF improved in patients whether or not they had 
      revascularization. In the revascularization group, 14% of dysfunctional segments 
      with LGE <25% and 22% of dysfunctional segments with LGE <50% had improved 
      contractile function. However, the transmural extent of LGE did not predict 
      contractile recovery following revascularization or pharmacological therapy 
      (P = 0.19, P = 0.42). LVEDV improved overall (280 +/- 77 to 269 +/- 83 mL, P = 0.05); 
      improvement was associated with heart failure duration (P = 0.04). CONCLUSIONS: 
      In patients with chronic severe LV impairment of ischaemic origin, duration of 
      heart failure is a better predictor of recovery than transmural extent of LGE, 
      following medical therapy or successful revascularization. This suggests that the 
      extent of myocardial remodelling is more important for LV recovery than the 
      presence and extent of prior infarction alone and that LGE should not be the sole 
      determinant of treatment method in severe LV systolic dysfunction of ischaemic 
      origin.
CI  - (c) 2015 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on 
      behalf of the European Society of Cardiology.
FAU - McDiarmid, Adam K
AU  - McDiarmid AK
AD  - Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular 
      and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, 
      University of Leeds, Leeds, UK.
FAU - Loh, Huan
AU  - Loh H
AD  - Academic Cardiology Unit, University of Hull, Castle Hill Hospital, Kingston upon 
      Hull, UK.
FAU - Nikitin, Nikolay
AU  - Nikitin N
AD  - Academic Cardiology Unit, University of Hull, Castle Hill Hospital, Kingston upon 
      Hull, UK.
FAU - Cleland, John G
AU  - Cleland JG
AD  - Academic Cardiology Unit, University of Hull, Castle Hill Hospital, Kingston upon 
      Hull, UK.
FAU - Ball, Stephen G
AU  - Ball SG
AD  - Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular 
      and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, 
      University of Leeds, Leeds, UK.
FAU - Greenwood, John P
AU  - Greenwood JP
AD  - Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular 
      and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, 
      University of Leeds, Leeds, UK.
FAU - Plein, Sven
AU  - Plein S
AD  - Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular 
      and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, 
      University of Leeds, Leeds, UK.
FAU - Sparrow, Patrick
AU  - Sparrow P
AD  - Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular 
      and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, 
      University of Leeds, Leeds, UK.
LA  - eng
PT  - Journal Article
DEP - 20150113
PL  - England
TA  - ESC Heart Fail
JT  - ESC heart failure
JID - 101669191
OTO - NOTNLM
OT  - Heart failure
OT  - Magnetic resonance
OT  - Recovery
OT  - Viability
EDAT- 2014/12/01 00:00
MHDA- 2014/12/01 00:01
CRDT- 2017/08/24 06:00
PHST- 2014/08/28 00:00 [received]
PHST- 2014/10/17 00:00 [revised]
PHST- 2014/11/05 00:00 [accepted]
PHST- 2017/08/24 06:00 [entrez]
PHST- 2014/12/01 00:00 [pubmed]
PHST- 2014/12/01 00:01 [medline]
AID - 10.1002/ehf2.12019 [doi]
PST - ppublish
SO  - ESC Heart Fail. 2014 Dec;1(2):146-153. doi: 10.1002/ehf2.12019. Epub 2015 Jan 13.