Background
Methods
Study population
CMR imaging protocol and image post-processing
LGE quantification
Follow-up of clinical endpoints
Statistical analysis
Results
All patients (n = 670) | |
---|---|
Baseline
| |
Age (year) | 47.8 ± 16.0 |
Female sex | 278 (41%) |
BMI, kg/m2 | 27.8 ± 6.3 |
Acuteness of Presentation
| |
Acute chest pain syndromes (< 2 weeks) | 350 (52%) |
Subacute presentation (> 2 weeks) with dyspnea or left ventricular dysfunction | 201 (30%) |
Subacute presentation (> 2 weeks) with ventricular arrhythmias, syncopal spells or abnormal ECG | 119 (18%) |
Prior Cardiovascular History
| |
Hypertension | 181 (27%) |
Tobacco | 76 (11%) |
Diabetes | 60 (9%) |
Dyslipidemia | 138 (21%) |
Medications
| |
Aspirin | 186 (28%) |
ACE inhibitors | 229 (35%) |
Beta-blockers | 266 (40%) |
Diuretics | 135 (21%) |
Statins | 142 (22%) |
Insulin | 23 (4%) |
ECG
| |
Abnormal ECG | 278 (42%) |
Laboratory Testing’s
| |
Troponin abnormal | 170 (63%) |
Creatine-kinase abnormal | 70 (40%) |
White blood cell count abnormal | 105 (35%) |
All patients (n = 670) | |
---|---|
LVEF (%) | 50 ± 15 |
LVEDVi (ml/m2) | 98 ± 33 |
LVESVi (ml/m2) | 53 ± 34 |
LV mass index (g/m2) | 61 ± 17 |
RVEF (%) | 49 ± 11 |
RVEDVi (ml/m2) | 80 ± 21 |
RVESVi (ml/m2) | 42 ± 17 |
Pericardial effusion | 169 (25%) |
T2- weighted imaging (SIR ≥2) | 124 (27%) |
LGE presence | 292 (44%) |
LGE-VPS | 1.7 ± 3.4 |
LGE-VTS | 4.2 ± 8.9 |
LGE mass (g) | |
- 2-SD | 5.5 ± 10.6 |
- 3-SD | 3.7 ± 7.7 |
- 4-SD | 2.6 ± 5.8 |
- 5-SD | 1.7 ± 4.1 |
- 6-SD | 1.2 ± 3.2 |
- 7-SD | 0.8 ± 2.4 |
- FWHM | 2.7 ± 5.3 |
LGE mass (%) | |
- 2-SD | 4.7 ± 8.8 |
- 3-SD | 3.1 ± 6.5 |
- 4-SD | 2.2 ± 4.9 |
- 5-SD | 1.5 ± 3.5 |
- 6-SD | 1.0 ± 2.7 |
- 7-SD | 0.7 ± 2.1 |
- FWHM | 2.2 ± 4.5 |
LGE extent and outcome
MACE | ||
---|---|---|
Potential Predictors | HR (95% CI) | p value |
Baseline
| ||
Age (year) | 1.03 (1.01–1.04) | < 0.001 |
Female sex | 1.60 (1.07–2.38) | 0.021 |
Body mass index (kg/m2) | 1.05 (1.02–1.08) | 0.001 |
Referral reasons
| ||
Acute (< 2 weeks) vs. subacute presentation (≥2 weeks) | 1.87 (1.22–2.86) | 0.003 |
History
| ||
Hypertension | 1.72 (1.14–2.61) | 0.011 |
Tobacco | 1.59 (0.99–2.58) | 0.057 |
Diabetes | 2.51 (1.49–4.22) | 0.001 |
Dyslipidemia | 1.46 (0.93–2.28) | 0.101 |
Medications
| ||
Aspirin | 1.47 (1.19–1.82) | < 0.001 |
ACE inhibitors | 1.80 (1.21–2.68) | 0.004 |
Beta-blockers | 2.34 (1.55–3.51) | < 0.001 |
Diuretics | 3.03 (2.01–4.56) | < 0.001 |
Statins | 1.50 (0.95–2.35) | 0.080 |
Insulin | 3.62 (1.82–7.21) | < 0.001 |
ECG
| ||
Abnormal ECG | 1.16 (0.78–1.74) | 0.455 |
Laboratory Testing’s
| ||
Troponin abnormal | 1.01 (0.57–1.79) | 0.968 |
Creatine-kinase abnormal | 1.19 (0.62–2.29) | 0.596 |
White blood cell count abnormal | 1.79 (1.09–2.92) | 0.021 |
CMR characteristics
| ||
LVEF (%) | 0.95 (0.94–0.97) | < 0.001 |
LVEDVi (ml/m2) | 1.01 (1.00–1.02) | < 0.001 |
LVESVi (ml/m2) | 1.01 (1.01–1.02) | < 0.001 |
LV mass index (g/m2) | 1.01 (1.00–1.03) | 0.021 |
RVEF (%) | 0.95 (0.93–0.96) | < 0.001 |
RVEDVi (ml/m2) | 1.00 (0.99–1.01) | 0.570 |
RVESVi (ml/m2) | 1.02 (1.01–1.03) | < 0.001 |
Pericardial effusion | 2.31 (1.54–3.45) | < 0.001 |
T2- weighted imaging (SIR ≥2) | 2.14 (1.30–3.52) | 0.003 |
CMR LGE quantifications methods
| ||
LGE mass (g) | ||
- 2-SD | 1.02 (1.00–1.03) | 0.011 |
- 3-SD | 1.02 (0.99–1.04) | 0.064 |
- 4-SD | 1.02 (0.99–1.05) | 0.162 |
- 5-SD | 1.01 (0.97–1.06) | 0.356 |
- 6-SD | 1.01 (0.95–1.07) | 0.754 |
- 7-SD | 1.00 (0.92–1.09) | 0.973 |
- FWHM | 1.04 (1.02–1.06) | 0.001 |
CMR LGE visual assessment
| ||
LGE presence | 2.22 (1.47–3.35) | < 0.001 |
LGE-VPS | 1.09 (1.04–1.15) | < 0.001 |
LGE-VTS | 1.02 (1.01–1.04) | < 0.001 |
Model 1 | Model 2 | ||||
Variables
|
HR (95% CI)
|
p-value
|
Variables
|
HR (95% CI)
|
p-value
|
Age (years) | 1.02 (1.01–1.04) | 0.001 | Age (years) | 1.03 (1.01–1.04) | 0.001 |
Sex | 1.73 (1.15–2.60) | 0.009 | Sex | 1.77 (1.17–2.65) | 0.007 |
BMI | 1.05 (1.02–1.08) | 0.002 | BMI | 1.05 (1.02–1.08) | 0.002 |
LVEF | 0.96 (0.95–0.97) | < 0.001 | LVEF | 0.96 (0.95–0.97) | < 0.001 |
LGE (%, FWHM) |
1.04 (1.01–1.08)
|
0.009
|
LGE (%, 2-SD)
| 1.02 (1.00–1.04) |
0.035
|
Model 3 | Model 4 | ||||
Variables
|
HR (95% CI)
|
p-value
|
Variables
|
HR (95% CI)
|
p-value
|
Age (years) | 1.03 (1.01–1.04) | 0.001 | Age (years) | 1.02 (1.00–1.04) | 0.001 |
Sex | 1.74 (1.16–2.62) | 0.008 | Sex | 1.74 (1.12–2.61) | 0.008 |
BMI | 1.05 (1.02–1.08) | 0.002 | BMI | 1.05 (1.02–1.08) | 0.003 |
LVEF | 0.96 (0.95–0.97) | < 0.001 | LVEF | 0.96 (0.95–0.97) | < 0.001 |
LGE (%, 3-SD) |
1.02 (0.99–1.05)
|
0.117
|
LGE (%, 4-SD)
|
1.02 (0.98–1.05)
|
0.309
|
Model 5 | Model 6 | ||||
Variables
|
HR (95% CI)
|
p-value
|
Variables
|
HR (95% CI)
|
p-value
|
Age (years) | 1.02 (1.00–1.04) | 0.001 | Age (years) | 1.02 (1.01–1.04) | 0.002 |
Sex | 1.74 (1.16–2.61) | 0.008 | Sex | 1.70 (1.13–2.55) | 0.010 |
BMI | 1.05 (1.02–1.08) | 0.002 | BMI | 1.05 (1.02–1.08) | 0.002 |
LVEF | 0.96 (0.95–0.97) | < 0.001 | LVEF | 0.96 (0.95–0.97) | < 0.001 |
LGE (VPS) |
1.07 (1.02–1.13)
|
0.005
|
LGE (VTS)
| 1.01 (1.00–1.03) |
0.087
|
Model 7 | |||||
Variables
|
HR (95% CI)
|
p-value
| |||
Age (years) | 1.02 (1.01–1.04) | 0.005 | |||
Sex | 1.79 (1.19–2.70) | 0.005 | |||
BMI | 1.05 (1.02–1.08) | 0.001 | |||
LVEF | 0.96 (0.95–0.98) | < 0.001 | |||
LGE presence |
1.82 (1.17–2.81)
|
0.008
|