Document Detail

Prevalence of regional myocardial thinning and relationship with myocardial scarring in patients with coronary artery disease.
MedLine Citation:
PMID:  23462787     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: Regional left ventricular (LV) wall thinning is believed to represent chronic transmural myocardial infarction and scar tissue. However, recent case reports using delayed-enhancement cardiovascular magnetic resonance (CMR) imaging raise the possibility that thinning may occur with little or no scarring.
OBJECTIVE: To evaluate patients with regional myocardial wall thinning and to determine scar burden and potential for functional improvement.
DESIGN, SETTING, AND PATIENTS: Investigator-initiated, prospective, 3-center study conducted from August 2000 through January 2008 in 3 parts to determine (1) in patients with known coronary artery disease (CAD) undergoing CMR viability assessment, the prevalence of regional wall thinning (end-diastolic wall thickness ≤5.5 mm), (2) in patients with thinning, the presence and extent of scar burden, and (3) in patients with thinning undergoing coronary revascularization, any changes in myocardial morphology and contractility.
MAIN OUTCOMES AND MEASURES: Scar burden in thinned regions assessed using delayed-enhancement CMR and changes in myocardial morphology and function assessed using cine-CMR after revascularization.
RESULTS: Of 1055 consecutive patients with CAD screened, 201 (19% [95% CI, 17% to 21%]) had regional wall thinning. Wall thinning spanned a mean of 34% (95% CI, 32% to 37% [SD, 15%]) of LV surface area. Within these regions, the extent of scarring was 72% (95% CI, 69% to 76% [SD, 25%]); however, 18% (95% CI, 13% to 24%) of thinned regions had limited scar burden (≤50% of total extent). Among patients with thinning undergoing revascularization and follow-up cine-CMR (n = 42), scar extent within the thinned region was inversely related to regional (r = -0.72, P < .001) and global (r = -0.53, P < .001) contractile improvement. End-diastolic wall thickness in thinned regions with limited scar burden increased from 4.4 mm (95% CI, 4.1 to 4.7) to 7.5 mm (95% CI, 6.9 to 8.1) after revascularization (P < .001), resulting in resolution of wall thinning. On multivariable analysis, scar extent had the strongest association with contractile improvement (slope coefficient, -0.03 [95% CI, -0.04 to -0.02]; P < .001) and reversal of thinning (slope coefficient, -0.05 [95% CI, -0.06 to -0.04]; P < .001).
CONCLUSIONS AND RELEVANCE: Among patients with CAD referred for CMR and found to have regional wall thinning, limited scar burden was present in 18% and was associated with improved contractility and resolution of wall thinning after revascularization. These findings, which are not consistent with common assumptions, warrant further investigation.
Dipan J Shah; Han W Kim; Olga James; Michele Parker; Edwin Wu; Robert O Bonow; Robert M Judd; Raymond J Kim
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  JAMA     Volume:  309     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-06     Completed Date:  2013-03-08     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  909-18     Citation Subset:  AIM; IM    
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MeSH Terms
Cicatrix / pathology*
Coronary Artery Disease / pathology*,  surgery
Heart Ventricles / pathology*
Magnetic Resonance Imaging
Middle Aged
Myocardial Contraction*
Myocardial Infarction / pathology
Myocardial Revascularization*
Prospective Studies
Recovery of Function
Grant Support
Comment In:
JAMA. 2013 Jul 10;310(2):207   [PMID:  23839760 ]
JAMA. 2013 Jul 10;310(2):207-8   [PMID:  23839761 ]
JAMA. 2013 Mar 6;309(9):929-30   [PMID:  23462791 ]

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