CAD: Chronic Coronary Syndromes

1350721 - Interactions between right ventricular dysfunction and myocardial scar quantification by cardiac magnetic resonance in ischemic cardiomyopathy

Thursday, January 26, 2023

1:00 PM – 2:00 PM

Location: Pacific Jewel

Presenting Author(s)

TW

Tom Kai Ming Wang, MBChB MD

Cardiologist
Cleveland Clinic, United States

Primary Author(s)

TW

Tom Kai Ming Wang, MBChB MD

Cardiologist
Cleveland Clinic, United States

Co-Author(s)

DS

Donna Salam, MD

Research Fellow
Cleveland Clinic, United States
MT

Mustafa Turkmani, MD

Research fellow
Cleveland Clinic, United States
DA

Danah Al-Deiri, MD

Research Fellow
Cleveland Clinic, United States
ZP

Zoran Popovic, MD, PhD

Cardiologist
Cleveland Clinic, Ohio, United States
JB

Jennifer Bullen, MSc

Statistician
Cleveland Clinic, United States
WT

Wilson Tang, MD

Cardiologist
Cleveland Clinic, United States
BG

Brian Griffin, MD

Cardiologist
Cleveland Clinic, Ohio, United States
Christopher Nguyen, PhD, FACC, FSCMR

Director
Cleveland Clinic
Cleveland, Ohio, United States
Scott Flamm, MD, FSCMR

Radiologist
Cleveland Clinic
Shaker Heights, Ohio, United States
Debbie Kwon, MD

Staff Physician
Cleveland Clinic
Cleveland, Ohio, United States

Disclosure(s):

Christopher Nguyen, PhD, FSCMR: No financial relationships to disclose

Debbie Kwon, MD: No financial relationships to disclose

Background: Cardiac magnetic resonance (CMR) is an indispensable tool for right ventricle quantification as the reference standard, however how it interacts with myocardial scar detected on CMR in ischemic cardiomyopathy (ICM) is not well understood. We analyzed the prognostic value and interactions of right ventricular ejection fraction (RVEF) with LGE in ICM.

Methods: We retrospectively studied adult ICM (n=771) patients who had CMR during 2002-2017. The primary endpoint was a composite of all-cause death, heart transplant or LVAD during follow-up, from which multivariable Cox regression and interaction analyses were performed, with focus on RVEF and late gadolinium enhancement (LGE) scar quantification.

Results: Key cohort characteristics were 190 (24.6%) females, mean age 62.3±11.2 years, RVEF 43±14%, LGE 12±11%, and the primary outcome occurred in 455 (59.0%) patients during follow-up 6.4±5.2 years. Although RVEF and LGE per 5% increase were significantly associated with the primary outcome in univariable analysis with hazards ratios (95%CI) of 0.956 (0.932-0.990) and 1.05 (1.02-1.08) respectively, only LGE remained so in multivariable analysis with hazards ratio (95%CI) of 1.05 (1.01-1.10, P=0.022. However, there was a significant interaction between RVEF and LGE (P=0.013), and the survival curves are shown in the Figure, where the highest risk group was RVEF<40% and LGE>5% while other groups had similar survival.

Conclusion: Significant interaction was identified between reduced RVEF and higher LGE for worse prognosis in ICM. These findings stress the importance of interpreting RVEF and LGE in conjunction, rather than in isolation, for risk stratification for ICM.