Prediction of global left ventricular functional recovery in patients with heart failure undergoing surgical revascularisation, based on late gadolinium enhancement Cardiovascular Magnetic Resonance

Tammy J. Pegg, Joseph B. Selvanayagam, Joslin Jennifer, Jane M. Francis, Theodoros D. Karamitsos, Erica Dall'Armellina, Karen L. Smith, David P. Taggart, Stefan Neubauer

Research output: Contribution to journalReview article

48 Citations (Scopus)

Abstract

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.

LanguageEnglish
Article number56
JournalJournal of Cardiovascular Magnetic Resonance
Volume12
Issue number1
DOIs
Publication statusPublished - 1 Dec 2010

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Pegg, Tammy J. ; Selvanayagam, Joseph B. ; Jennifer, Joslin ; Francis, Jane M. ; Karamitsos, Theodoros D. ; Dall'Armellina, Erica ; Smith, Karen L. ; Taggart, David P. ; Neubauer, Stefan. / Prediction of global left ventricular functional recovery in patients with heart failure undergoing surgical revascularisation, based on late gadolinium enhancement Cardiovascular Magnetic Resonance. In: Journal of Cardiovascular Magnetic Resonance. 2010 ; Vol. 12, No. 1.
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title = "Prediction of global left ventricular functional recovery in patients with heart failure undergoing surgical revascularisation, based on late gadolinium enhancement Cardiovascular Magnetic Resonance",
abstract = "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.",
author = "Pegg, {Tammy J.} and Selvanayagam, {Joseph B.} and Joslin Jennifer and Francis, {Jane M.} and Karamitsos, {Theodoros D.} and Erica Dall'Armellina and Smith, {Karen L.} and Taggart, {David P.} and Stefan Neubauer",
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Prediction of global left ventricular functional recovery in patients with heart failure undergoing surgical revascularisation, based on late gadolinium enhancement Cardiovascular Magnetic Resonance. / Pegg, Tammy J.; Selvanayagam, Joseph B.; Jennifer, Joslin; Francis, Jane M.; Karamitsos, Theodoros D.; Dall'Armellina, Erica; Smith, Karen L.; Taggart, David P.; Neubauer, Stefan.

In: Journal of Cardiovascular Magnetic Resonance, Vol. 12, No. 1, 56, 01.12.2010.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Prediction of global left ventricular functional recovery in patients with heart failure undergoing surgical revascularisation, based on late gadolinium enhancement Cardiovascular Magnetic Resonance

AU - Pegg, Tammy J.

AU - Selvanayagam, Joseph B.

AU - Jennifer, Joslin

AU - Francis, Jane M.

AU - Karamitsos, Theodoros D.

AU - Dall'Armellina, Erica

AU - Smith, Karen L.

AU - Taggart, David P.

AU - Neubauer, Stefan

PY - 2010/12/1

Y1 - 2010/12/1

N2 - 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.

AB - 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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U2 - 10.1186/1532-429X-12-56

DO - 10.1186/1532-429X-12-56

M3 - Review article

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JO - Journal of Cardiovascular Magnetic Resonance

T2 - Journal of Cardiovascular Magnetic Resonance

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