Prognostic Value of Late Gadolinium Enhanced Magnetic Resonance Imaging in Patients with and without Left Ventricular Dysfunction Who Underwent Coronary Artery Bypass Graft Surgery

Abstract

Purpose To evaluate the long-term prognostic value of late gadolinium enhanced (LGE) magnetic resonance imaging (MRI), based on the presence or absence of LV dysfunction, in patients with coronary artery disease (CAD) who undergo coronary artery bypass graft surgery (CABG). Materials and Methods The institutional review board approved the study and waived the need for written informed consent. One hundred forty-six consecutive patients (age, 64 ± 9 years

male, 72%) underwent cine- and LGE-MRI before CABG. Adverse cardiac events were cardiac death, nonfatal myocardial infarction, heart failure, and unstable angina. The Cox proportional hazards model was used in event-free survival analysis. Results During a median follow up of 9.4 years, 44 (30.1%) patients experienced adverse cardiac events. In the overall study population, LGE presence (adjusted hazard ratio [HR], 2.58

P = 0.027), score (per score

adjusted HR, 1.06

P < 0.001) and extent (per percent

adjusted HR, 1.08

P < 0.001) were independent predictors of adverse cardiac events. The LGE presence (adjusted HR, 4.48

P = 0.007), score (adjusted HR, 1.14

P < 0.001), and extent (adjusted HR, 1.18

P < 0.001) were independently associated with adverse cardiac events in patients with LVEF ≥50%. Only LGE extent was an independent predictor of adverse cardiac events (adjusted HR, 1.16

P = 0.038) in patients with LVEF <50%. Conclusions The qualitative and quantitative analysis of myocardial scar using LGE-MRI provides long-term prognostic information after surgical revascularization. The LGE extent was a strong predictor of adverse cardiac events, independent of LV function.