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Prevalence and prognosis of non-ischemic patterns of late gadolinium enhancement in older adults by cardiovascular MR in the ICELAND-MI study

Year: 2016
Type: article
Abstract: Late gadolinium enhancement (LGE) can detect and discriminate myocardial scar/fibrosis of ischemic and non-ischemic etiologies. Our objective was to determine the prevalence and prognosis for ischemic and non-ischemic patterns of LGE in a community-based sample of older adults. ICELAND-MI is a nested cohort of the Age, Gene/Environment Susceptibility-Reykjavik Study of community-dwelling older adults that intentionally over-sampled diabetic subjects. After excluding subjects with pre-existing heart failure, the cohort size was 900. CMR was used to detect myocardial infarction (MI), major patterns of non-ischemic patterns of LGE as defined by Vöhringer (Herz 2007;32:129-37), and minor patterns of non-ischemic LGE including LGE near the aortic root, mitral annulus, or right ventricular insertion points. The composite end-point was adjudicated hospitalization for heart failure and death. The median age was 76 (IQR 72-81), 48% were male, and 35% had diabetes. The prevalence of MI, major non-ischemic patterns of LGE, and minor non-ischemic patterns of LGE were 23.4%(N = 211), 6.0%(N = 54), and 26.4%(N = 238) respectively. Major non-ischemic LGE demonstrated the highest risk (HR 3.5, p < 0.0001, Figure 1 ), MI had similar risk (HR 2.5, p < 0.0001), and minor non-ischemic LGE had lower but significantly higher risk (HR1.5, p = 0.03) compared to those without LGE. Controlling for age, gender, LVEF, diabetes, and hypertension, major non-ischemic LGE remained strongly predictive of the composite endpoint (HR 2.3, p = 0.001) while minor non-ischemic patterns of LGE were of borderline significance (p = 0.07). Kaplan-Meier Event Rates for Subjects with Major Non-ischemic LGE, MI, Minor Non-ischemic LGE versus Normal LGE . Subjects with major non-ischemic LGE patterns are at increased risk of developing heart failure and death.
DOI: 10.1186/1532-429x-18-s1-o61
Authors: Sujata M Shanbhag, Thor Aspelund, Anders M Greve, Gudmundur Thorgeirsson, Erik B Schelbert, Jie J Cao, Sigurdur Sigurdsson, Peter Kellman, Gudny Eiriksdottir, Tamara Harris, Lenore Launer, Vilmundur Gudnason, Andrew E Arai
Institutions: National Institutes of Health, National Heart, Lung, and Blood Institute, University of Iceland, Icelandic Heart Association, Gentofte Hospital, UPMC Health System, University of Pittsburgh Medical Center, St. Francis Hospital, National Institute on Aging
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $3,000
OpenAlex ID: W2325569835
FWCI:
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Cited by: 1
Related to: 10