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Incremental prognostic value of cardiovascular magnetic resonance imaging in patients with severe LV dysfunction
Baiyan Zhuang1, Shuang Li1, Hui Wang1
1Department of Radiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.
Insights
Cardiovascular magnetic resonance (CMR) imaging, using left atrial diameter index and scar burden, improves prognosis prediction for patients with coronary artery disease (CAD) and low ejection fraction undergoing bypass surgery.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiovascular Surgery
Background:
- Coronary artery disease (CAD) with left ventricular ejection fraction (LVEF) < 35% poses significant risks.
- Coronary artery bypass grafting (CABG) is recommended, but prognosis remains uncertain.
Purpose of the Study:
- To evaluate the prognostic value of cardiovascular magnetic resonance (CMR) imaging.
- To determine if CMR enhances clinical management guidance for CAD patients with LVEF < 35% undergoing CABG.
Main Methods:
- Retrospective analysis of 152 patients with CAD and LVEF < 35% who underwent CABG.
- Enhanced CMR imaging using a 3.0T scanner.
- Prognostic analysis of clinical and CMR data, with endpoints including cardiovascular death, revascularization, heart failure hospitalization, and stroke.
Main Results:
- Left atrial diameter index (LADi) and late gadolinium enhancement (LGE) mass were significant predictors of adverse events.
- These CMR markers improved risk prediction beyond traditional clinical factors (C-index: 0.738, IDI: 0.36, NRI: 0.13).
Conclusions:
- LADi and scar burden (LGE mass) are valuable prognostic indicators in this patient group.
- CMR-derived metrics enhance risk stratification, aiding clinical decision-making for patients with CAD and LVEF < 35% undergoing CABG.
Background:
Coronary artery disease (CAD) remains a significant global health issue, particularly when complicated by left ventricular ejection fraction (LVEF) < 35%. Although coronary artery bypass grafting (CABG) is recommended for such cases, the unclear prognosis necessitates further investigation.
Method:
This retrospective study aimed to determine whether cardiovascular magnetic resonance (CMR) imaging provides additional prognostic value in guiding effective clinical management. The study included patients with CAD and LVEF < 35% who underwent CABG surgery after enhanced CMR between March 2016 and March 2023. CMR was performed using a 3.0T scanner with steady-state free precession and phase-sensitive inversion recovery sequences. Prognostic analysis of clinical and CMR data was conducted, with the endpoint defined as cardiovascular death, revascularization, hospitalization for heart failure, or stroke. Statistical analysis included Student's t-test, chi-squared test, univariate and multivariate Cox regression analysis, receiver operating characteristic analysis, Harrell C statistical analysis, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) analysis.
Result:
The study included 152 patients (mean age 58.6 ± 9.7 years; 138 men). During a mean follow-up of 2.0 years, 8 patients experienced cardiovascular death, while 1 case had revascularization, 13 had hospitalization for heart failure, and 11 had a stroke. Left atrial diameter index (LADi) (hazard ratio [HR], 1.08 [95% confidence interval (CI): 1.02-1.15]; P = 0.04) and late gadolinium enhancement (LGE) mass (HR, 1.03 [95% CI: 1.01-1.06]; P < 0.001) were associated with the endpoint, even after adjusting for multiple clinical variables. Adding LADi and LGE mass improved risk prediction for adverse events, as indicated by the C-index (0.738, p < 0.01), IDI (0.36), and NRI (0.13).
Conclusion:
Left atrial diameter index (LADi) and scar burden are valuable prognostic indicators in patients with LVEF < 35% undergoing CABG. They offer enhanced risk stratification beyond traditional clinical factors, highlighting their importance in guiding clinical management.
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