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Delayed-enhancement MRI (DE-MRI) shows promise as a predictor of cardiac transplantation and all-cause mortality in the largest trial to assess the prognostic value of DE-MRI-identified myocardial scarring over a relatively long follow-up.

A review of 857 consecutive patients undergoing DE-MRI at St Luke's Episcopal Hospital by Dr Benjamin Cheong (Texas Heart Institute, Houston, TX) and colleagues found that myocardial fibrosis, which appears enhanced in MRI images about 15 minutes after the patient is given a dose of gadolinium chelate, correlates to worse odds of transplant-free survival. Results of the study were published online November 9, 2009 in Circulation.

Patients in the study were followed for an average of 4.4 years. The primary end point, all-cause mortality or cardiac transplantation, was reached by 29% of patients in the study.

Cheong et al recommend cardiovascular MRI as the "preferred method of measuring LV function. Exquisite contrast, spatial, and temporal resolutions and a lack of geometric assumptions make CV MRI measurement of LV volumes both accurate and reproducible."

The trial's most important finding, according to the authors, "was that even in the presence of traditional cardiovascular prognosticators, DE-MRI was a strong, independent predictor of death/transplantation. Furthermore, our results emphasize that the combination of LVEF and DE-MRI carries independent prognostic information." The study found that patients with scarring apparent in DE-MRI images and an LVEF greater than 50% had almost an identical transplant-free survival rate to patients with LVEF under 50% but no scarring identified by DE-MRI.

Source: Heartwire

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