The Association between Left Ventricular Diastolic Dysfunction and Myocardial Scar and Their Collective Impact on
Lin Wang1, Harsimar Singh2, Rajasekhar R Mulyala2
1St. Francis Hospital, The Heart Center, Roslyn, New York; State University of New York at Stony Brook, Stony Brook, New York.
Insights
Myocardial scar and left ventricular diastolic dysfunction (DD) significantly increase cardiovascular mortality risk. Combining these conditions amplifies the risk, emphasizing the importance of assessing myocardial tissue in patients with DD.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac Pathology
Background:
- Left ventricular diastolic dysfunction (DD) and myocardial scar are critical factors in cardiovascular disease.
- These conditions contribute significantly to patient morbidity and mortality.
Purpose of the Study:
- To investigate the hypothesis that myocardial scar acts as a substrate for DD.
- To determine if DD and myocardial scar collectively increase all-cause mortality risk.
Main Methods:
- 607 patients underwent echocardiography and cardiac magnetic resonance imaging.
- Diastolic dysfunction (DD) was assessed using echocardiography, and myocardial scar by late gadolinium enhancement (LGE).
- All-cause mortality was tracked over a 10-year follow-up period.
Main Results:
- Scar prevalence and burden increased with DD severity (p < .001).
- Mortality incidence was substantially higher in patients with advanced DD and higher LGE scores (p < .001).
- A significant additive interaction between DD and scar for mortality was observed (p < .001).
Conclusions:
- A strong association exists between echocardiographic DD findings and myocardial tissue changes.
- DD assessment effectively stratifies mortality risk.
- Myocardial tissue characterization is crucial for managing mortality risk in patients with DD, given the additive impact of scar.
Background:
Left ventricular diastolic dysfunction (DD) and myocardial scar are important contributors to cardiovascular morbidity and mortality. The aim of this study was to test the hypothesis that myocardial scar is a substrate of DD and that collectively they contribute to increased risk for all-cause mortality.
Methods:
The study included 607 consecutive patients who underwent echocardiography and cardiac magnetic resonance imaging within 1 week. DD was assessed by echocardiography according to the contemporary guidelines and myocardial scar by late gadolinium enhancement (LGE). All-cause mortality was the main outcome.
Results:
Scar prevalence was significantly higher comparing no DD with mild and advanced DD (25%, 61%, and 80%, respectively; P < .001), and scar burden was greater by semiquantitative LGE scores (1.4 ± 3.4, 4.8 ± 6.3, and 6.8 ± 8.8, respectively; P < .001). After 10 years of follow-up, 50 patients (8.2%) had died. The mortality incidence was significantly higher comparing no DD with mild and advanced DD (2.5, 17.3, and 55.7 deaths per 1,000 person-years, respectively; P < .001). It was also higher in patients with higher LGE scores (4.3, 22.7, and 35.2 deaths per 1,000 person-years in groups with LGE scores of 0, 1-6, and ≥7, respectively; P < .001). The risk for death was higher among patients with both DD and scar. The additive interaction of DD and scar for mortality was significant (P < .001). In the multivariate Cox proportional-hazards analysis, DD and scar were associated with mortality (P < .001).
Conclusions:
There is a strong link between the echocardiographic findings of DD and the morphologic changes of myocardial tissue. DD assessed according to contemporary guidelines effectively differentiates mortality risk. The additive interaction of DD and scar on mortality risk highlights the pivotal role of myocardial tissue characterization in patients with DD.
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