Original title: Prevalence of Regional Myocardial Thinning and Relationship With Myocardial Scarring in Patients With Coronary Artery Disease. Reference: Dipan J. Shah et al. JAMA. 2013;309(9):909-918
Regional left ventricular (LV) wall thinning is believed to represent chronic myocardial infarction. In fact, the most recent guidelines, both European and American, have concluded that “Images that show regional myocardial thinning in absence of contraction with no other cause than the ischemic, are diagnosed as chronic infarction”. Regional left ventricular (LV) wall thinning is believed to represent chronic myocardial infarction. However, recent case reports using delayed-enhancement cardiovascular magnetic resonance (CMR) imaging raise the possibility that thinning may occur with little or no scarring.
The recent incorporation of Delayed Enhancement MR imaging to the study of patients with ischemic heart disease could change the previous paradigm. This prospective study included 1055 patients with a history of ischemic heart disease between 2000 and 2008, where diagnosed through 1.5T DE-MR in 1.5T. A ≤ 5.5 mm thinning was considered at the end of diastole. Scarring tissue was also analyzed (hyperintense areas) within thinning. Of 1055 patients analyzed, 201 (19%) had regional wall thinning of some LV area.
Among patients with thinning undergoing revascularization and follow-up CMR (RR=0.72, p<0.001), there was improvement in the systolic global function (RR=0.53, p<0.001) and a reduction in end-diastole volume (RR=0.42, p=0.007). It was also observed that the Q waves disappeared from the ECG. The latter was inversely correlated to scar extent within the thinned region.
Conclusion:
Among patients with CAD referred for CMR and found to have regional wall thinning, limited scar burden was present in 18% and was associated with improved contractility and resolution of wall thinning after revascularization.
Editorial Comment:
This study has a major limitation, the decision to revascularize was left to the attending physicians, which could affect selection. These results contradict the present guidelines and paradigmes and require further randomized studies for confirmation.
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