Boyce, Steven

Elagha, Abdalla

Fuisz, Anthon R

Hill, Peter C

Kancharla, Krishna

Weissman, Gaby

Journal of Cardiovascular Magnetic Resonance

English

PubMed

Abdalla Elagha

Krishna Kancharla

Peter C Hill

Steven Boyce

Gaby Weissman

Anthon R Fuisz

Springer - Publisher Connector

Scar assessment by cardiac MRI can predict outcome in high-risk patients undergoing coronary artery bypass graft (CABG)

ORAL PRESENTATION Open Access
Scar assessment by cardiac MRI can predict
outcome in high-risk patients undergoing
coronary artery bypass graft (CABG)
Abdalla Elagha1*, Krishna Kancharla2, Peter C Hill2, Steven Boyce2, Gaby Weissman2, Anthon R Fuisz2
From 2011 SCMR/Euro CMR Joint Scientific Sessions
Nice, France. 3-6 February 2011
Objectives
The aim of the study is to determine whether the
presence and distribution of myocardial infarct scar,
detected by delayed-hyperenhancement (DHE-CMR),
predicts survival outcome in high-risk patients under-
going CABG.
Background
Cardiac Magnetic Resonance (CMR)-imaging has an
excellent sensitivity and specificity in myocardial scar
detection. For patients undergoing CABG, the Society of
Thoracic Surgeons (STS) risk-score is an established
prognostic tool of survival outcome. The relation
between presence of myocardial scar and overall survival
after CABG is not well identified. Surprisingly, many
patients without evident scar may have unfavorable out-
come after CABG, a phenomenon which could be
attributed to presence of concomitant non-ischemic
cardiomyopathy.
Methods
We studied a total of 202 patients, who underwent
CMR ≤30 days prior to CABG-surgery (2003-2010). The
mean and median STS-score were calculated for further
risk stratification (higher or lower-risk group). Images of
DHE-CMR were acquired in all patients, and classified
as (1) No scar (2) Single-vessel territory scar (LAD,
LCX, RCA) (3) Multi-vessel territory scars with and
without LAD territory. The LVEF, demographic data,
risk factors were recorded. Odds ratio, Fisher’s exact,
and Kaplan-Meier survival tests were used for statistical
analysis.
Results
Average follow-up period was 3.6 years. The mean and
median STS-score were 1.35% and 2.34%, respectively.
Higher and lower risk groups were defined as having
STS-score > and ≤ 2.34%, respectively. In patients with
lower STS-score, no statistically significant survival dif-
ference was observed among different scar distribution
groups. However, In patients with higher STS-score,
those with multi-segment scars pattern including LAD
territory had the highest observed long-term mortality
92% (12 out-of 13), which was significantly higher than
both single-territory group 38% (13 out-of 34, p=0.001)
and no scar group 67% (8 out-of 12, p=0.003). An inter-
esting observation was noted in higher STS-score group;
patients in no scar group had a worse long-term
mortality outcome (67%) after CABG compared to 24%
(4 out-of 13) in LAD-scar only group (similar EF also),
Odds ratio is 6.5, P= 0.02. Figure 1.
Conclusions
CMR imaging can predict survival in patients under-
going CABG. Scar evaluation by DHE-CMR may have
an additive long-term prognostic value to STS-score. In
patients with higher STS-score; (1) Those with multi-
segment scar pattern have the worst outcome, (2) Some
patients without myocardial scar appear to convey an
unfavorable prognosis, which represent a vulnerable
1NIH, Bethesda, MD, USA
Full list of author information is available at the end of the article
Elagha et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O88
http://jcmr-online.com/content/13/S1/O88
© 2011 Elagha et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
group that needs further careful evaluation, and should
draws attention to exclude concomitant non-ischemic
cardiomyopathy.
Author details
1NIH, Bethesda, MD, USA. 2Washington Hospital Center, Washington DC,
DC, USA.
Published: 2 February 2011
doi:10.1186/1532-429X-13-S1-O88
Cite this article as: Elagha et al.: Scar assessment by cardiac MRI can
predict outcome in high-risk patients undergoing coronary artery
bypass graft (CABG). Journal of Cardiovascular Magnetic Resonance 2011
13(Suppl 1):O88.
Submit your next manuscript to BioMed Central
and take full advantage of: 
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at 
www.biomedcentral.com/submit
Figure 1
Elagha et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O88
http://jcmr-online.com/content/13/S1/O88
Page 2 of 2


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ORAL PRESENTATION Open AccessScar assessment by cardiac MRI can predictoutcome in high-risk patients undergoingcoronary artery bypass graft (CABG)Abdalla Elagha1*, Krishna Kancharla2, Peter C Hill2, Steven Boyce2, Gaby Weissman2, Anthon R Fuisz2From 2011 SCMR/Euro CMR Joint Scientific SessionsNice, France. 3-6 February 2011ObjectivesThe aim of the study is to determine whether thepresence and distribution of myocardial infarct scar,detected by delayed-hyperenhancement (DHE-CMR),predicts survival outcome in high-risk patients under-going CABG.BackgroundCardiac Magnetic Resonance (CMR)-imaging has anexcellent sensitivity and specificity in myocardial scardetection. For patients undergoing CABG, the Society ofThoracic Surgeons (STS) risk-score is an establishedprognostic tool of survival outcome. The relationbetween presence of myocardial scar and overall survivalafter CABG is not well identified. Surprisingly, manypatients without evident scar may have unfavorable out-come after CABG, a phenomenon which could beattributed to presence of concomitant non-ischemiccardiomyopathy.MethodsWe studied a total of 202 patients, who underwentCMR ≤30 days prior to CABG-surgery (2003-2010). Themean and median STS-score were calculated for furtherrisk stratification (higher or lower-risk group). Images ofDHE-CMR were acquired in all patients, and classifiedas (1) No scar (2) Single-vessel territory scar (LAD,LCX, RCA) (3) Multi-vessel territory scars with andwithout LAD territory. The LVEF, demographic data,risk factors were recorded. Odds ratio, Fisher’s exact,and Kaplan-Meier survival tests were used for statisticalanalysis.ResultsAverage follow-up period was 3.6 years. The mean andmedian STS-score were 1.35% and 2.34%, respectively.Higher and lower risk groups were defined as havingSTS-score > and ≤ 2.34%, respectively. In patients withlower STS-score, no statistically significant survival dif-ference was observed among different scar distributiongroups. However, In patients with higher STS-score,those with multi-segment scars pattern including LADterritory had the highest observed long-term mortality92% (12 out-of 13), which was significantly higher thanboth single-territory group 38% (13 out-of 34, p=0.001)and no scar group 67% (8 out-of 12, p=0.003). An inter-esting observation was noted in higher STS-score group;patients in no scar group had a worse long-termmortality outcome (67%) after CABG compared to 24%(4 out-of 13) in LAD-scar only group (similar EF also),Odds ratio is 6.5, P= 0.02. Figure 1.ConclusionsCMR imaging can predict survival in patients under-going CABG. Scar evaluation by DHE-CMR may havean additive long-term prognostic value to STS-score. Inpatients with higher STS-score; (1) Those with multi-segment scar pattern have the worst outcome, (2) Somepatients without myocardial scar appear to convey anunfavorable prognosis, which represent a vulnerable1NIH, Bethesda, MD, USAFull list of author information is available at the end of the articleElagha et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O88http://jcmr-online.com/content/13/S1/O88© 2011 Elagha et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.group that needs further careful evaluation, and shoulddraws attention to exclude concomitant non-ischemiccardiomyopathy.Author details1NIH, Bethesda, MD, USA. 2Washington Hospital Center, Washington DC,DC, USA.Published: 2 February 2011doi:10.1186/1532-429X-13-S1-O88Cite this article as: Elagha et al.: Scar assessment by cardiac MRI canpredict outcome in high-risk patients undergoing coronary arterybypass graft (CABG). Journal of Cardiovascular Magnetic Resonance 201113(Suppl 1):O88.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitFigure 1Elagha et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O88http://jcmr-online.com/content/13/S1/O88Page 2 of 2

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Scar assessment by cardiac MRI can predict outcome in high-risk patients undergoing coronary artery bypass graft (CABG)

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