N.D. Oryshchyn.Assessment of the myocardial viability by magnetic resonance imaging for prediction of functional recovery after revascularization in patients with ischemic cardiomyopathy

The aim – to assess the prognostic value of MRI-derived segmental late hyperenhancement extent as a predictor of the functional recovery of myocardial segments after revascularization in patients with ischemic cardiomyopathy.

Material and methods. We enrolled 40 patients with heart failure due to the systolic dysfunction and performed cardiac MRI with late gadolinium enhancement. Segmental extent of hyperenhancement was calculated in all patients. Revascularization was performed in 12 patients. We assessed segmental contractility before and 3–6 month after revascularization and compared the degree of functional improvement of the segment with different extent of hyperenhancement.

Results. Segments with low extent of hyperenhancement (1–25 %) improved systolic function in 70 %, segments with extent of hyperenhancement up to 50 % – in 50 %, segments with hyperenhancement 75 % and more – in 2.7 %. Based on echocardiographic segmental functional recovery 3–6 months after revascularization, we calculated the prognostic value of the late hyperenhancement extent that might be used to distinguish between viable and nonviable segments. The sensitivity of the segmental late hyperenhancement extent in prediction of segmental functional recovery was 70.8 %, the specificity – 84.9 % with cut-off 50 %.

Conclusions. Likelihood of the systolic function improvement in segments with low extent of late hyperenhancement (0–50 %) is high. Segments with high extent of late hyperenhancement (> 75 %) could be considered as non-viable. Cardiac MRI with late gadolinium enhancement is a sensitive and specific method of prediction of functional recovery after revascularization.

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