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The Impact of Cardiac Magnetic Resonance Imaging on Revascularization in Ischemic Left Ventricular Dysfunction
Ghada Shalaby1,2, Abeer Bakhsh1, Aseel Jamal3
1Department of Cardiology, King Abdullah Medical City, Makkah 21955, Saudi Arabia.
Insights
Cardiac MRI (CMR) did not independently affect outcomes in patients undergoing revascularization. The sum scar score and microvascular obstruction (MVO) were not linked to cardiovascular events in this study.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Severe left ventricular (LV) dysfunction presents revascularization challenges with high complication rates.
- Cardiac magnetic resonance (CMR) is utilized in managing these patients, but the prognostic significance of scar burden and microvascular obstruction (MVO) is not fully understood.
Purpose of the Study:
- To evaluate the impact of revascularization decisions guided by CMR findings on patient outcomes.
- To assess the prognostic value of the sum scar score and MVO in patients with severe LV dysfunction.
Main Methods:
- Retrospective analysis of 145 patients undergoing CMR between 2023-2025 at King Abdullah Medical City.
- Exclusion criteria included normal LV function, absence of angiogram reports, or incomplete CMR.
- Primary outcome: hospitalization or death, comparing revascularized versus medically treated patients.
Main Results:
- The cohort (mean age 56.7 years, 90.3% male) had high cardiovascular risk factors.
- Revascularization (PCI or CABG) was performed in 45.5% of patients.
- No significant differences in hospitalization (p=0.61) or mortality (p=0.31) between revascularized and medical therapy groups were observed.
Conclusions:
- CMR did not independently influence hospitalization or mortality in the revascularization versus medical therapy groups.
- Microvascular obstruction (MVO) and left ventricular ejection fraction (LVEF) scar score were not significantly associated with cardiovascular outcomes.
- The study was underpowered with significant loss to follow-up, limiting generalizability.
Background:
There are ongoing challenges in revascularizing patients with severe left ventricular (LV) dysfunction, with high rates of short- and long-term complications. Cardiac magnetic resonance (CMR) imaging is widely used for these patients; however, the prognostic value of the sum scar score and microvascular obstruction (MVO) remains unclear.
Method:
A retrospective study of data from King Abdullah Medical City (KAMC) between 2023 and 2025 was conducted to evaluate revascularization decisions made based on CMR studies. Patients who had normal LV function, no angiogram report, or incomplete CMR imaging were excluded. The primary outcome was hospitalization or death in patients with or without revascularization.
Results:
The cohort included 145 patients. The patients had a mean age of 56.7 ± 9.7 years and were predominantly male 131 (90.3%), with a high prevalence of cardiovascular risk factors: diabetes 102 (70.8%), hypertension 84 (58.7%), known dyslipidemia 46 (32%), and smoking 65 (45.5%). Most patients underwent a viability study within 7 days of a myocardial infarction (MI), 58 (40%), and a further 42 (28.9%) did so within 7-15 days. The CMR LVEF was 29.5 ± 8, and the sum scar score was 38.8 ± 21.9; MVO was observed in 34 patients (23.4%). The number of patients who underwent revascularization at the index admission was 66 (45.5%), of whom 48 (33%) received percutaneous intervention (PCI) and 18 (12.4%) underwent coronary artery bypass surgery (CABG). The patients lost to follow-up numbered 51 (35%). There were no significant differences between the two groups for the primary endpoints, including hospitalization (p-value: 0.61) and mortality (p-value: 0.31).
Conclusion:
In this retrospective study, CMR did not have an independent effect on hospitalization or mortality in patients who had revascularization compared to medical therapy groups. MVO and the LGE scar score were not significantly associated with cardiovascular outcomes. Our cohort was underpowered, with a high proportion of patients lost to follow-up, limiting the generalizability of the data.
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