Abstract 17750: Inferior Myocardial Infarction is an Independent and Incremental Predictor of Mortality in Patients with Severe Ischemic Cardiomyopathy - A Delayed Enhancement MRI Study

Abstract

BACKGROUND: Myocardial scar burden assessed by delayed enhancement MRI (DE-MRI) is a powerful predictor of mortality in patients with severe ischemic cardiomyopathy (ICM). Anterior scar (AS) is thought to be more predictive of mortality, but it unclear if this is due to infarct size rather than location. We hypothesized that infarct location assessed by DE-MRI provides independent and incremental value in the prognostication of all-cause mortality over clinical, echocardiographic, and DE-MRI data.

METHODS: We studied 411 pts with ischemic cardiomyopathy (LV dysfunction with >70% stenosis in ≥1 epicardial coronary artery) underwent DE-MRI (Avanto, Siemens) between 2002-2006. Scar was defined as ≥2SD of the defined remote myocardium. Regional scar assessment was conducted using the 17 segment AHA model. A multivariable Cox proportional hazards (CPH) model, (primary end-point of all-cause mortality) was conducted to evaluate the association of infarct location with survival.

RESULTS: There were 186(45%)death over a mean 5.5y follow-up (mean LVEF 23±9%, mean ESVi 115±48 ml, mean scar% 30±17%, mean AS% 37±23%, mean lateral scar (LS)% 24±20%, mean inferior scar (IS)% 16±21%). Scar locations were separately entered into the model. Only inferior scar was found to be an independent predictor (AS % ß=0.003, p=0.403 LS% ß=0.003, p=.502), and total scar% was no longer significant after the addition of IS%. See Table 1 for multivariate model (X2 increased from 121 to 126 with addition of IS%, p<0.001).

CONCLUSION: After controlling for infarct size, IS%, but not AS%, is an independent and incremental predictor of mortality in patients with severe (ICM).