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Gender differences in survival in patients with severe left ventricular dysfunction despite similar extent of myocardial scar measured on cardiac magnetic resonance
Author(s) -
Kwon Deborah H.,
Halley Carmel M.,
Popovic Zoran B.,
Carrigan Thomas P.,
Zysek Victoria,
Setser Randolph,
Schoenhagen Paul,
Flamm Scott D.,
Starling Randall C.,
Desai Milind Y.
Publication year - 2009
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfp118
Subject(s) - medicine , ejection fraction , cardiology , hazard ratio , interquartile range , coronary artery disease , heart failure , cardiac magnetic resonance imaging , cardiac magnetic resonance , magnetic resonance imaging , heart transplantation , confidence interval , radiology
Aims We sought to determine the association between myocardial scarring, gender, and survival in patients with significant coronary artery disease (CAD) and severe systolic left ventricular (LV) dysfunction using delayed hyper‐enhancement cardiac magnetic resonance imaging (DHE‐CMR). Methods and results We studied 339 patients (24% women, mean age 65 ± 11 years) referred for assessment of myocardial viability by DHE‐CMR. Scar was defined as myocardium with an intensity >2 SD above viable myocardium. Left ventricular scar (defined as a percentage of total LV myocardium), LV volumes, risk factors, cardiac transplantation (CTx), and all‐cause mortality were recorded. There were 84 deaths and five CTx over 3.7 ± 1.6 years (median 4 years, interquartile range 2.6–4.9 years). Left ventricular ejection fraction (LVEF) in men was only slightly different from women (23% ± 9 vs. 25% ± 10, P = 0.05), whereas mean scar % was similar in both groups (32 ± 21 vs. 29 ± 20, P = 0.3). On univariable survival analysis, age [hazard ratio, HR, 1.03 (1.01–1.05), P = 0.002], female gender [HR 2.02 (1.31–3.12), P = 0.001], and scar % [HR 1.01 (1.003–1.02), P = 0.009] predicted outcomes; and also on multivariable analysis (χ 2 32, P < 0.0001). Women with scar % greater than the median had more events, compared with men with or without a high scar burden (log‐rank P < 0.001). Conclusion In patients with CAD and severely reduced LVEF, women have worse outcomes than men, irrespective of myocardial scar burden.