Abstract 17731: Prognostic Value of Peri-infarct and Core infarct Area in Patients with Severe Ischemic Cardiomyopathy and Differences in Associations with Clinical Parameters

Abstract

BACKGROUND: Peri-infarct (PI), but not core infarct (CI) area, have previously been demonstrated to be independently associated with adverse outcomes. However, it is unknown if infarct characterization remains independently predictive after controlling for clinical and echocardiographic assessment.

PURPOSE: We sought to assess the prognostic power of PI% and CI% over clinical and echocardiographic assessment and their associations with clinical parameters.

METHODS: A total of 494 pts with ischemic cardiomyopathy (LV dysfunction with >70% stenosis in ≥1 epicardial coronary artery) underwent delayed hyperenhancement-MRI (Avanto, Siemens) between 2002-2006. Total infarct (TI) was defined as ≥2SD of the defined remote myocardium. CI was defined as >3 SDs and 2-3 SD for PI. Quantification of infarct heterogeneity was expressed as a percentage of PI or CI mass/left ventricular mass. Multivariate survival analysis, (primary end-point of all-cause mortality) was conducted. Multivariate logistic regression modelling was performed to identify associations with PI% and CI%.

RESULTS: There were 212 (43%)deaths over a mean 5.5y follow-up (mean LVEF 23±9%, mean ESVi 115±48 ml, mean TI% 30 ± 17%, mean PI% 6 ± 4%, and mean CI% 24±16%). PI% (ß 0.08, p=0.001) and CI% (ß 0.017,p=0.001), were independent predictors of survival, independent of age, end systolic volume, gender, mitral regurgitation (ß 0.875, p=0.02), renal function (ß -0.011, p=0.001), diabetes, hypertension, dyslipidemia, CAD severity, incomplete revascularization (ß 0.266,p=0.005), presence of ICD (ß 0.017,p=0.001), LBBB, and diastolic dysfunction (ß 0.289,p=0.016). Multivariate logistic regression revealed significantly different associations of PI% and CI% with clinical variables. Table 1.

CONCLUSION: PI% and CI% both provide independent prognostic value, but demonstrate very different associations with clinical parameters.