Abstract 20276: Late Gadolinium Enhancement is Associated With Preclinical Myocardial Dysfunction in Women With Signs and Symptoms of Ischemia and No Obstructive Coronary Artery Disease
Introduction: Cardiac magnetic resonance imaging (CMRI) late gadolinium enhancement (LGE) identifies myocardial injury and predicts adverse outcomes in the stable ischemic heart disease (SIHD). Whether LGE is related to preclinical myocardial dysfunction in women with signs and symptoms of ischemia, no obstructive coronary artery disease (CAD), and preserved left ventricular ejection fraction (LVEF) has not been evaluated.
Methods: Women with signs and symptoms of ischemia and no obstructive CAD underwent 1.5T CMRI with assessment of LGE and cardiac function, in the Women’s Ischemia Syndrome Evaluation – Coronary Vascular Dysfunction (WISE-CVD). Independent τ-tests, χ2 testing, Pearson’s correlation, and linear regression models were used for analysis.
Results: Among 348 women, mean age 51.8 ± 11.4 yrs, LGE was present in 9.2%, 59.4% with subendocardial distribution, mean size 5.9±4.4 grams. Women with LGE were more likely to be taking calcium channel blockers (CCB), had lower blood pressure and LVEF as well as higher end-diastolic and end-systolic volumes compared to women without LGE (Table). Despite all women having a preserved LVEF, myocardial scar size inversely correlated with LVEF (r = -0.63, p < 0.001). Specifically, we observed a 0.78 decrease in LVEF % for every 1 gram of scar (95% CI: -1.22 to -0.34, p = 0.001) in a linear regression model adjusted for hypertension, ACE-I, ARB, beta blocker, and CCB use.
Conclusion: Among women with signs and symptoms of ischemia, no obstructive CAD and preserved LVEF, LGE is associated with preclinical myocardial dysfunction measured by LVEF, end-diastolic, and end-systolic volumes. Despite relatively small size, LGE size has an inverse relationship to LVEF within the normal range, suggesting that LGE may be related to diffuse fibrosis in these subjects. Detection and quantification of LGE offers promise for understanding relations between SIHD and heart failure with preserved LVEF in patients with no obstructive CAD.
Author Disclosures: N. Darouian: None. J. Wei: None. S. Landes: None. A. AlBadri: None. L.E. Thomson: None. J. Petersen: None. D.S. Berman: None. E. Handberg: None. C.J. Pepine: None. C. Bairey Merz: Research Grant; Modest; Microvascular, Normal Control. Research Grant; Significant; WISE HFpEF, RWISE, FAMRI. Speakers Bureau; Modest; Pri-Med, Practice Point. Honoraria; Modest; Beaumont Hospital, Florida Hospital, Korean Cardiology Society, Practice Point Communications, University of Colorado, University of Utah, Washington University, Harold Buchwald Heart Health. Consultant/Advisory Board; Significant; Research Triangle Institute (RTI). Other; Modest; NIH-CASE Grant Review Study Session.
- © 2016 by American Heart Association, Inc.