Journal of Cardiovascular Magnetic Resonance (Jan 2024)

Unrecognized myocardial scar by late-gadolinium-enhancement cardiovascular magnetic resonance: Insights from the population-based Hamburg City Health Study

  • Ersin Cavus,
  • Jan N. Schneider,
  • Eleonora di Carluccio,
  • Andreas Ziegler,
  • Alena Haack,
  • Francisco Ojeda,
  • Celeste Chevalier,
  • Charlotte Jahnke,
  • Katharina A. Riedl,
  • Ulf K. Radunski,
  • Raphael Twerenbold,
  • Paulus Kirchhof,
  • Stefan Blankenberg,
  • Gerhard Adam,
  • Enver Tahir,
  • Gunnar K. Lund,
  • Kai Muellerleile

Journal volume & issue
Vol. 26, no. 1
p. 101008

Abstract

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ABSTRACT: Background: The presence of myocardial scar is associated with poor prognosis in several underlying diseases. Late-gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging reveals clinically silent “unrecognized myocardial scar” (UMS), but the etiology of UMS often remains unclear. This population-based CMR study evaluated prevalence, localization, patterns, and risk factors of UMS. Methods: The study population consisted of 1064 consecutive Hamburg City Health Study participants without a history of coronary heart disease or myocarditis. UMS was assessed by standard-phase-sensitive-inversion-recovery LGE CMR. Results: Median age was 66 [quartiles 59, 71] years and 37% (388/1064) were females. UMS was detected in 244 (23%) participants. Twenty-five participants (10%) had ischemic, and 217 participants (89%) had non-ischemic scar patterns, predominantly involving the basal inferolateral left-ventricular (LV) myocardium (75%). Two participants (1%) had coincident ischemic and non-ischemic scar. The presence of any UMS was independently associated with LV ejection fraction (odds ratios (OR) per standard deviation (SD) 0.77 (confidence interval (CI) 0.65–0.90), p = 0.002) and LV mass (OR per SD 1.54 (CI 1.31–1.82), p < 0.001). Ischemic UMS was independently associated with LV ejection fraction (OR per SD 0.58 (CI 0.39–0.86), p = 0.007), LV mass (OR per SD 1.74 (CI 1.25–2.45), p = 0.001), and diabetes (OR 4.91 (CI 1.66–13.03), p = 0.002). Non-ischemic UMS was only independently associated with LV mass (OR per SD 1.44 (CI 1.24–1.69), p < 0.001). Conclusion: UMS, in particular with a non-ischemic pattern, is frequent in individuals without known cardiac disease and predominantly involves the basal inferolateral LV myocardium. Presence of UMS is independently associated with a lower LVEF, a higher LV mass, and a history of diabetes.

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