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Myocardial scar mortality ischemic cardiomyopathy

Hafeez Ul Hassan Virk, Salman Farooq, Ali Raza Ghani, Shilpkakumar Arora
The electrocardiogram (ECG) is a commonly available basic diagnostic modality in in-patient, out-patient, and emergency departments. In patients with coronary artery disease (CAD), the presence of a fragmented QRS (f-QRS), which is an extra R wave (R'), notching of the single R wave, notching of the S wave in at least two contiguous leads on the 12-lead ECG, is associated with a myocardial scar from previous myocardial injury. Furthermore, the presence of f-QRS has been shown to be associated with adverse outcomes in CAD and non-CAD patients...
2016: Journal of Community Hospital Internal Medicine Perspectives
Sandra Hamada, Joerg Schroeder, Rainer Hoffmann, Ertunc Altiok, Andras Keszei, Mohammad Almalla, Andreas Napp, Nikolaus Marx, Michael Becker
BACKGROUND: Cardiac magnetic resonance imaging (CMR) has been established as a powerful tool for predicting mortality. However, its application is limited by availability and various contraindications. The aim of this study was to evaluate the predictive value of layer-specific myocardial deformation analysis as assessed by strain echocardiography for cardiac events in patients with chronic ischemic left ventricular dysfunction in comparison with CMR. METHODS: Three hundred ninety patients (mean age, 63 ± 4 years; 69% men; mean left ventricular ejection fraction [LVEF], 41 ± 7%) with chronic ischemic cardiomyopathy were prospectively enrolled and underwent strain echocardiography and CMR within 3 ± 1 days...
May 2016: Journal of the American Society of Echocardiography
Philip R Liebson
Advances in the novel approach to control ischemic heart disease and heart failure using stem cells or progenitor cells from bone marrow, mesenchyme, or myocardial tissue itself have demonstrated efficacy for increasing left ventricular function, decreasing infarct scar tissue, improving exercise tolerance and heart failure symptoms, and, in some studies, decreasing mortality and reducing rehospitalization for intractable angina or subsequent myocardial infarction. The most common techniques utilize injections of cells into the coronary vasculature or directly into specific areas of vulnerable myocardium...
May 2015: Clinical Cardiology
Fatma Demirel, Ahmet Adiyaman, Jorik R Timmer, Jan-Henk E Dambrink, Mariël Kok, Willem Jan Boeve, Arif Elvan
OBJECTIVES: We hypothesized that myocardial scar characterization using cardiac magnetic resonance imaging (CMR) may be associated with the occurrence of ventricular tachyarrhythmia (VT), appropriate implantable cardioverter-defibrillator (ICD) therapy and mortality. BACKGROUND: Since a minority of patients with prophylactic ICD implantation receive appropriate ICD therapy, there is a need for more effective risk stratification for primary prevention in patients with ischemic cardiomyopathy...
December 15, 2014: International Journal of Cardiology
Siok P Lim, Brian A Mc Ardle, Rob S Beanlands, Renee C Hessian
Heart failure presents a significant problem in industrialized countries, with a high prevalence, morbidity, and mortality, where it is most frequently caused by coronary artery disease. Revascularization in patients with symptomatic heart failure has been associated with improved cardiovascular outcomes. Predictors of outcome benefit from revascularization include the presence and extent of hibernating myocardium, ischemia, scar, left ventricular ejection fraction, and renal function. Viability is useful in directing the management of patients with ischemic cardiomyopathy...
September 2014: Seminars in Nuclear Medicine
Thomas A Holly, Robert O Bonow, J Malcolm O Arnold, Jae K Oh, Padmini Varadarajan, Gerald M Pohost, Haissam Haddad, Robert H Jones, Eric J Velazquez, Bozena Birkenfeld, Federico M Asch, Marcin Malinowski, Rodrigo Barretto, Renato A K Kalil, Daniel S Berman, Jie-Lena Sun, Kerry L Lee, Julio A Panza
OBJECTIVES: In the Surgical Treatment for Ischemic Heart Failure trial, surgical ventricular reconstruction plus coronary artery bypass surgery was not associated with a reduction in the rate of death or cardiac hospitalization compared with bypass alone. We hypothesized that the absence of viable myocardium identifies patients with coronary artery disease and left ventricular dysfunction who have a greater benefit with coronary artery bypass graft surgery and surgical ventricular reconstruction compared with bypass alone...
December 2014: Journal of Thoracic and Cardiovascular Surgery
Deborah H Kwon, Lisa Asamoto, Zoran B Popovic, Kenya Kusunose, Monique Robinson, Milind Desai, Thomas H Marwick, Scott D Flamm
BACKGROUND: Infarct heterogeneity has been shown to be independently associated with adverse outcomes in previous smaller studies. However, it is unknown whether infarct characterization is an independent predictor of all-cause mortality in patients with advanced ischemic cardiomyopathy, after adjusting for clinical risk factors, severity of ischemic mitral regurgitation, incomplete revascularization, and device therapy. METHODS AND RESULTS: A total of 362 patients with ischemic cardiomyopathy (left ventricular dysfunction with >70% stenosis in ≥1 epicardial coronary artery) underwent delayed hyperenhancement-magnetic resonance imaging and coronary angiography between 2002 and 2006...
September 2014: Circulation. Cardiovascular Imaging
João L Cavalcante, Thomas H Marwick, Rory Hachamovitch, Zoran B Popovic, Nael Aldweib, Randall C Starling, Milind Y Desai, Scott D Flamm, Deborah H Kwon
UNLABELLED: Cardiac magnetic resonance (CMR) identifies important prognostic variables in ischemic cardiomyopathy (ICM) patients such as left ventricular (LV) volumes, LV ejection fraction (LVEF), peri-infarct zone, and myocardial scar burden (MSB). It is unknown whether Doppler-based diastolic dysfunction (DDF) retains its prognostic value in ICM patients, in the context of current imaging, medical, and device therapies. METHODS: Diastolic function was evaluated in ICM patients (LVEF ≤ 40% and ≥ 70% stenosis in ≥ 1 coronary artery) who underwent transthoracic echocardiogram and delayed hyperenhancement CMR studies within 7 days...
August 2014: American Heart Journal
Bobak Heydari, Raymond Y Kwong
Despite significant advancements in the treatment of ischemic heart disease (IHD), IHD remains a leading cause of mortality and morbidity. In addition, there remains clinical equipoise regarding a number of important management issues across the spectrum of IHD, from evaluating patients with chest pain in the emergency department, to deciding whether patients with chronic stable angina or severe ischemic cardiomyopathies should undergo invasive revascularization procedures. Recent data over the past 2 decades has demonstrated that cardiac magnetic resonance imaging is highly accurate and carries robust prognostic value in the evaluation of patients with both acute and chronic IHD...
February 2014: Topics in Magnetic Resonance Imaging: TMRI
Abhishek Bose, Jagdesh Kandala, Gaurav A Upadhyay, Lindsay Riedl, Imad Ahmado, Ram Padmanabhan, Henry Gewirtz, Lawrence J Mulligan, Jagmeet P Singh
INTRODUCTION: Cardiac resynchronization therapy (CRT) recipients with ischemic cardiomyopathy (ICM) have scar segments that may limit ventricular resynchronization and clinical response. The impact of myocardial viability at the left ventricular (LV) pacing site on CRT response is poorly elucidated. METHODS AND RESULTS: A retrospective cohort of 160 ICM patients with single photon emission computed tomography-myocardial perfusion imaging before device implantation were included...
May 2014: Journal of Cardiovascular Electrophysiology
Mischa T Rijnierse, Stefan de Haan, Hendrik J Harms, Lourens F Robbers, LiNa Wu, Ibrahim Danad, Aernout M Beek, Martijn W Heymans, Albert C van Rossum, Adriaan A Lammertsma, Cornelis P Allaart, Paul Knaapen
BACKGROUND: Risk stratification for ventricular arrhythmias (VAs) is important to refine selection criteria for primary prevention implantable cardioverter defibrillator therapy. Impaired hyperemic myocardial blood flow (MBF) is associated with increased mortality rate in ischemic and nonischemic cardiomyopathy, which may be attributed to electric instability inducing VAs. The aim of this pilot study was to assess whether hyperemic MBF impairment may be related with VA inducibility in patients with ischemic cardiomyopathy...
January 2014: Circulation. Cardiovascular Imaging
P Antonitsis, K Anastasiadis, G Koliakos, C Vaitsopoulou, K Kouzi-Koliakou, A Doumas, H Argiriadou, P Tossios
BACKGROUND: Ischemic cardiomyopathy has the distinctiveness of irreversible myocardial damage with scar tissue formation and mainly impaired perfusion of the remaining viable myocardium. We present results of the first series of patients with severe ischemic cardiomyopathy managed in our institution with intramyocardial implantation of autologous bone marrow stem cells at the time of coronary artery bypass grafting. The aim is to evaluate feasibility and safety of the procedure in our institution...
October 2012: Hippokratia
Christopher Uebleis, Stefan Hellweger, Rüdiger Paul Laubender, Alexander Becker, Hae-Young Sohn, Sebastian Lehner, Alexander Haug, Peter Bartenstein, Paul Cumming, Serge D Van Kriekinge, Piotr J Slomka, Marcus Hacker
To evaluate the prognostic significance of combined myocardial perfusion SPECT and [18F]FDG PET viability scanning for the prediction of survival in patients with ischemic cardiomyopathy (iCMP) and left ventricular dysfunction. 244 patients (64.0 ± 10.6 years, 86 % men) with iCMP and LVEF ≤ 45 % underwent SPECT/PET. Percent scar tissue and SPECT/PET-mismatch (%-mismatch) were calculated and correlated with event-free survival according to the type of therapy (medical therapy with/out revascularization) provided after imaging...
October 2013: International Journal of Cardiovascular Imaging
Roderick Tung, Yoav Michowitz, Ricky Yu, Nilesh Mathuria, Marmar Vaseghi, Eric Buch, Jason Bradfield, Osamu Fujimura, Jean Gima, William Discepolo, Ravi Mandapati, Kalyanam Shivkumar
BACKGROUND: Epicardial ablation has been shown to be a useful adjunct for treatment of ventricular tachycardia (VT). OBJECTIVE: To report the trends, safety, and efficacy of epicardial mapping and ablation at a single center over an 8-year period. METHODS: Patients referred for VT ablation (June 2004 to July 2011) were divided into 3 groups: ischemic cardiomyopathy (ICM), nonischemic cardiomyopathy (NICM), and idiopathic ventricular arrhythmias (VA)...
April 2013: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Deborah H Kwon, Rory Hachamovitch, Zoran B Popovic, Randall C Starling, Milind Y Desai, Scott D Flamm, Bruce W Lytle, Thomas H Marwick
BACKGROUND: The value of assessment of viability as a predictor of surgical revascularization benefit in ischemic cardiomyopathy has recently been questioned in a large trial. We sought to determine whether the contribution of viability as myocardial scar burden (SB) to predict revascularization outcomes could be modulated by end-systolic volume index (ESVi). METHODS AND RESULTS: Delayed hyperenhancement-MRI was obtained in 450 patients with ≥70% stenosis in ≥1 epicardial coronary artery (75% men; median age, 62...
September 11, 2012: Circulation
Wael AlJaroudi, M Chadi Alraies, Rory Hachamovitch, Wael A Jaber, Richard Brunken, Manuel D Cerqueira, Thomas Marwick
PURPOSE: LV mechanical dyssynchrony (LVMD) is a risk marker in narrow QRS cardiomyopathy, but its association with treatment outcome is not well defined. We determined the incremental prognostic value of LVMD in ischemic cardiomyopathy, and assessed its interaction with scar, myocardium in jeopardy and subsequent revascularization. METHODS: Stress and rest (82)Rb gated PET were performed in 486 consecutive patients (66 ± 11 years of age, 82 % men, LV ejection fraction 26 ± 6 %) with ischemic cardiomyopathy and QRS <120 ms...
October 2012: European Journal of Nuclear Medicine and Molecular Imaging
Danielle M Henkel, James Glockner, Wayne L Miller
The left ventricular (LV) scar size detected by cardiac magnetic resonance (CMR) imaging in ischemic cardiomyopathy (IC) has been correlated with mortality. However, the associations among myocardial fibrosis, ventricular geometry, and physiologic measures of myocardial performance remain to be defined. A retrospective analysis of patients with stable chronic IC (LV ejection fraction ≤50%) who underwent CMR imaging from 2004 to 2010 and had plasma B-type natriuretic peptide (BNP) measured within 14 days of the CMR study was undertaken...
February 1, 2012: American Journal of Cardiology
Adrianus P Wijnmaalen, Kurt C Roberts-Thomson, Daniel Steven, Robert J M Klautz, Stephan Willems, Martin J Schalij, William G Stevenson, Katja Zeppenfeld
BACKGROUND: After surgical ventricular restoration (SVR) for ischemic cardiomyopathy, ventricular tachycardias (VTs) are an important reason for postoperative morbidity and mortality. OBJECTIVE: The purpose of this study was to elucidate the VT substrate, VT characteristics, and outcome of radiofrequency catheter ablation (RFCA) in patients with VT after SVR. METHODS: Twelve (3%) of 416 patients referred for RFCA for VT after myocardial infarction in three centers had undergone SVR...
January 2012: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Kiyotake Ishikawa, Dennis Ladage, Yoshiaki Takewa, Elisa Yaniz, Jiqiu Chen, Lisa Tilemann, Susumu Sakata, Juan J Badimon, Roger J Hajjar, Yoshiaki Kawase
A number of promising therapies for ischemic cardiomyopathy are emerging, and the role of translational research in testing the efficacy and safety of these agents in relevant clinical models has become important. The goal of this study was to develop a chronic model of ischemic cardiomyopathy in a large animal model. In this study, 40 consecutive pigs were initially enrolled. To induce progressive stenosis, a plastic occluder with a fixed diameter of 1.0 mm fitted with an 18-gauge copper wire was placed around the proximal left anterior descending (LAD) coronary artery...
August 2011: American Journal of Physiology. Heart and Circulatory Physiology
Vincent Dor, Filippo Civaia, Clara Alexandrescu, Michel Sabatier, Françoise Montiglio
OBJECTIVE: We sought to examine the hemodynamic effects at 1 month and 1 year of left ventricular reconstruction by means of endoventricular patch plasty for patients with acute or chronic, very severe post-myocardial infarction heart failure who would have been systematically excluded from the Surgical Treatments for Ischemic Heart Failure (STICH) trial. METHODS: From 2002 to May 2008, 274 patients underwent left ventricular reconstruction for post-myocardial infarction scarring; 117 of these patients would not have been eligible for the STICH trial...
April 2011: Journal of Thoracic and Cardiovascular Surgery
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