Unrecognized myocardial scar by late-gadolinium-enhancement cardiovascular magnetic resonance: Insights from the population-based Hamburg City Health Study.

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Magnetic Resonance Pub Date : 2024-06-01 Epub Date: 2024-02-09 DOI:10.1016/j.jocmr.2024.101008
Ersin Cavus, Jan N Schneider, Eleonora di Carluccio, Andreas Ziegler, Alena Haack, Francisco Ojeda, Celeste Chevalier, Charlotte Jahnke, Katharina A Riedl, Ulf K Radunski, Raphael Twerenbold, Paulus Kirchhof, Stefan Blankenberg, Gerhard Adam, Enver Tahir, Gunnar K Lund, Kai Muellerleile
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引用次数: 0

Abstract

Background: The presence of myocardial scar is associated with poor prognosis in several underlying diseases. Late-gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging reveals clinically silent "unrecognized myocardial scar" (UMS), but the etiology of UMS often remains unclear. This population-based CMR study evaluated prevalence, localization, patterns, and risk factors of UMS.

Methods: The study population consisted of 1064 consecutive Hamburg City Health Study participants without a history of coronary heart disease or myocarditis. UMS was assessed by standard-phase-sensitive-inversion-recovery LGE CMR.

Results: Median age was 66 [quartiles 59, 71] years and 37% (388/1064) were females. UMS was detected in 244 (23%) participants. Twenty-five participants (10%) had ischemic, and 217 participants (89%) had non-ischemic scar patterns, predominantly involving the basal inferolateral left-ventricular (LV) myocardium (75%). Two participants (1%) had coincident ischemic and non-ischemic scar. The presence of any UMS was independently associated with LV ejection fraction (odds ratios (OR) per standard deviation (SD) 0.77 (confidence interval (CI) 0.65-0.90), p = 0.002) and LV mass (OR per SD 1.54 (CI 1.31-1.82), p < 0.001). Ischemic UMS was independently associated with LV ejection fraction (OR per SD 0.58 (CI 0.39-0.86), p = 0.007), LV mass (OR per SD 1.74 (CI 1.25-2.45), p = 0.001), and diabetes (OR 4.91 (CI 1.66-13.03), p = 0.002). Non-ischemic UMS was only independently associated with LV mass (OR per SD 1.44 (CI 1.24-1.69), p < 0.001).

Conclusion: UMS, in particular with a non-ischemic pattern, is frequent in individuals without known cardiac disease and predominantly involves the basal inferolateral LV myocardium. Presence of UMS is independently associated with a lower LVEF, a higher LV mass, and a history of diabetes.

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晚期钆增强心血管磁共振未识别的心肌瘢痕:基于人群的汉堡市健康研究的启示。
背景:心肌瘢痕的存在与多种潜在疾病的不良预后有关。晚期钆增强(LGE)心血管磁共振(CMR)成像可显示临床上无声的 "未识别心肌瘢痕"(UMS),但 UMS 的病因往往仍不清楚。这项基于人群的 CMR 研究评估了 UMS 的患病率、定位、模式和风险因素:研究对象包括 1064 名连续参加汉堡市健康研究的人员,他们均无冠心病或心肌炎病史。UMS通过标准相位敏感-反转恢复LGE CMR进行评估:中位年龄为66岁[四分位数59,71],37%为女性。244名参与者(23%)检测出 UMS。25名参与者(10%)有缺血性瘢痕,217名参与者(89%)有非缺血性瘢痕,主要涉及左心室(LV)心肌基底内外侧(75%)。两名参与者(1%)同时存在缺血性和非缺血性瘢痕。UMS的存在与左心室射血分数(OR per SD 0.77 (CI 0.65-0.90), p=0.002)和左心室质量(OR per SD 1.54 (CI 1.31-1.82), p结论:UMS(尤其是非缺血性模式)经常发生在没有已知心脏疾病的人群中,主要累及左心室下外侧基底心肌。未识别的心肌瘢痕的存在与较低的 LVEF 值、较高的左心室质量和糖尿病史密切相关。
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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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