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Laymouna R, El-Sharkawy E, El-Taha S, Elfiky M. Prognostic value of myocardial scar in ischaemic and non-ischaemic cardiomyopathy using cardiac magnetic resonance imaging. Cardiovasc J Afr 2023; 34:132-139. [PMID: 36162438 PMCID: PMC10658723 DOI: 10.5830/cvja-2022-040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/02/2022] [Indexed: 06/16/2023] Open
Abstract
AIM The aim of this research was to evaluate the prognostic value of myocardial scar using cardiac magnetic resonance (CMR) imaging in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM). METHODS One hundred and fifty-four patients with either ICM or NICM underwent CMR with late gadolinium enhancement sequences for assessment of left ventricular ejection fraction (LVEF), and detection and quantification of any myocardial scar using three methods: manual, number of segments involved, and percentage of scarred myocardium. Patients were followed up for at least six months for clinical cardiac events. RESULTS Patients were divided into two groups: group I, patients with ICM (58%) and group II, those with NICM (42%). Clinical presentation ranged from eventless lpar;10%) to chest pain (18%), heart failure (15%), hospitalisation (35%), syncope (1%), ventricular tachycardia (< 1%) and cardiac arrest (< 1%). The scar mass was larger in size in group I (17 ± 15%) than in group II (8 ± 13%). A direct relationship was observed between scar size and event severity (p < 0.001). An inverse relationship between LVEF and event severity was found in group I (p < 0.001) but not in group II (p = 0.128). CONCLUSIONS Myocardial scar size was a strong predictor of clinical outcome in both the ICM and NICM patients. LVEF was less reliable in predicting morbidity in cardiomyopathy patients.
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Affiliation(s)
- Reem Laymouna
- Cardiology and Angiology Department, Alexandria University, Alexandria, Egypt.
- International Cardiac Centre Scan, Alexandria, Egypt
| | - Eman El-Sharkawy
- Cardiology and Angiology Department, Alexandria University, Alexandria, Egypt
- International Cardiac Centre Scan, Alexandria, Egypt
| | - Salah El-Taha
- Cardiology and Angiology Department, Alexandria University, Alexandria, Egypt
- International Cardiac Centre Scan, Alexandria, Egypt
| | - Mohamed Elfiky
- Cardiology and Angiology Department, Alexandria University, Alexandria, Egypt
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Escobar C, Palacios B, Varela L, Gutiérrez M, Duong M, Chen H, Justo N, Cid-Ruzafa J, Hernández I, Hunt PR, Delgado JF. Prevalence, Characteristics, Management and Outcomes of Patients with Heart Failure with Preserved, Mildly Reduced, and Reduced Ejection Fraction in Spain. J Clin Med 2022; 11:5199. [PMID: 36079133 PMCID: PMC9456780 DOI: 10.3390/jcm11175199] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To estimate the prevalence, incidence, and describe the characteristics and management of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. Methods: Adults with ≥1 inpatient or outpatient HF diagnosis between 1 January 2013 and 30 September 2019 were identified through the BIG-PAC database. Annual incidence and prevalence by EF phenotype were estimated. Characteristics by EF phenotype were described in the 2016 and 2019 HF prevalent cohorts and outcomes in the 2016 HF prevalent cohort. Results: Overall, HF incidence and prevalence were 0.32/100 person-years and 2.34%, respectively, but increased every year. In 2019, 49.3% had HFrEF, 38.1% had HFpEF, and 4.3% had HFmrEF (in 8.3%, EF was not available). Compared with HFrEF, patients with HFpEF were largely female, older, and had more atrial fibrillation but less atherosclerotic cardiovascular disease. Among patients with HFrEF, 76.3% were taking renin-angiotensin system inhibitors, 69.5% beta-blockers, 36.8% aldosterone antagonists, 12.5% sacubitril/valsartan and 6.7% SGLT2 inhibitors. Patients with HFpEF and HFmrEF took fewer HF drugs compared to HFrEF. Overall, the event rates of HF hospitalization were 231.6/1000 person-years, which is more common in HFrEF patients. No clinically relevant differences were found in patients with HFpEF, regardless EF (50- < 60% vs. ≥60%). Conclusions: >2% of patients have HF, of which around 50% have HFrEF and 40% have HFpEF. The prevalence of HF is increasing over time. Clinical characteristics by EF phenotype are consistent with previous studies. The risk of outcomes, particularly HF hospitalization, remains high, likely related to insufficient HF treatment.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, University Hospital La Paz, 28046 Madrid, Spain
| | | | - Luis Varela
- AstraZeneca Farmaceutica, 28033 Madrid, Spain
| | | | | | | | - Nahila Justo
- Evidera, 113 21 Stockholm, Sweden
- Karolinska Institute, Department of Neurobiology, Care Sciences, and Society, 171 77 Stockholm, Sweden
| | | | | | | | - Juan F. Delgado
- Cardiology Department, University Hospital 12 de Octubre, CIBERCV, 28041 Madrid, Spain
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