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Prognostic value of unrecognised myocardial infarction detected by late gadolinium-enhanced MRI in diabetic patients with normal global and regional left ventricular systolic function

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Abstract

Objectives

To determine whether the detection of unrecognised myocardial infarction (MI) using late gadolinium-enhanced (LGE)-magnetic resonance imaging (MRI) can provide prognostic information in diabetic patients with normal ECG as well as normal global and regional left ventricular (LV) function.

Methods

From 449 diabetic patients who had complete cine- and LGE-MRI, 321 patients with histories of CAD, ischaemic ECG changes and abnormal cine MRI findings (LV ejection fraction <50 % or presence of regional wall motion abnormality) were excluded. The presence and extent of LGE were determined in the remaining 128 patients. Follow-up information was obtained for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death, acute MI, heart failure, unstable angina and significant ventricular arrhythmias in 120 patients.

Results

Of 120 patients, 18 (15 %) had LGE. During follow-up (median, 27 months), six patients with LGE (33.3 %) and four patients without LGE (3.9 %) experienced MACE, resulting in an annualised event rate of 7.7 % and 0.9 %, respectively (log-rank P <0.001). The presence of LGE was associated with an eight-fold increased hazard for MACE (HR, 8.84; P = 0.001).

Conclusions

LGE-MRI can detect unrecognised MI and may improve the risk stratification of diabetic patients with no CAD history, normal ECG and normal LV systolic function.

Key Points

• Late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) can identify subtle myocardial abnormalities.

• LGE-MRI can detect myocardial infarction missed by ECG and cine-MRI.

• Unrecognised MI detected by LGE-MRI was associated with adverse cardiac events.

• LGE-MRI helps clinicians to assess diabetic patients with unrecognised MI.

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Abbreviations

CAD:

Coronary artery disease

CI:

Confidence interval

DM:

Diabetes mellitus

ECG:

Electrocardiogram

LGE:

Late gadolinium enhancement

LV:

Left ventricle

MACE:

Major adverse cardiovascular event

MI:

Myocardial infarction

MRI:

Magnetic resonance imaging

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Authors and Affiliations

  1. Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Yeonyee E. Yoon, Kakuya Kitagawa, Shingo Kato & Hajime Sakuma

  2. Department of Cardiology, Mie University Hospital, Tsu, Mie, Japan

    Hiroshi Nakajima, Kaoru Dohi & Masaaki Ito

  3. Department of Cardiology, Matsusaka Central Hospital, Matsusaka, Mie, Japan

    Tairo Kurita

  4. Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea

    Yeonyee E. Yoon

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  1. Yeonyee E. Yoon
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Correspondence to Hajime Sakuma.

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Yoon, Y.E., Kitagawa, K., Kato, S. et al. Prognostic value of unrecognised myocardial infarction detected by late gadolinium-enhanced MRI in diabetic patients with normal global and regional left ventricular systolic function. Eur Radiol 23, 2101–2108 (2013). https://doi.org/10.1007/s00330-013-2817-y

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  • DOI: https://doi.org/10.1007/s00330-013-2817-y

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