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POSTER PRESENTATION Open Access
The impact of cardiac magnetic resonance
viability assessment on the management of
patients with ischaemic heart disease and left
ventricular dysfunction
Ben Cole
1*
, Hannah Douglas
1
, Chin Munn Soong
2
, Paul Horan
3
, Lana Dixon
1
, Nicola Johnston
1
, Mark Harbinson
2
From 18th Annual SCMR Scientific Sessions
Nice, France. 4-7 February 2015
Background
Identifying patients with ischaemic left ventricular dys-
function that would benefit from revascularisation as
opposed to medical therapy alone is challenging. Viabi-
lity assessment has in many centres become a gate-
keeper to revascularisation, however its use remains
controversial with several prospective randomised trials
showing no mortality benefit with this strategy. The aim
of this study was to investigate the role of cardiovascular
magnetic resonance (CMR) imaging in the decision
making process in patients being considered for revascu-
larisation at our institution.
Methods
All patients referred for CMR viability assessment at a
single regional centre were identified retrospectively
between January 2011 and March 2013 inclusive. CMR
scans were reviewed and segmental viability was deter-
mined using the AHA segmental model with viability
defined as less than 50% delayed contrast enhancement.
Patient records were reviewed to determine the ultimate
revascularisation strategy as well as patient outcomes.
Results
324 consecutive patients were identified, of which 256
were being considered for revascularisation. The remain-
der were undergoing viability assessment for other
reasons, for example valvular heart disease. Of the
patients being considered for revascularisation, 38
(14.4%) had preserved left ventricular (LV) systolic
function, 33 (17.3%) mild LV dysfunction, 77 (28.4%)
moderate LV dysfunction and 108 (39.9%) severe LV
dysfunction. Of the patients with severe LV dysfunction
22 subsequently underwent coronary artery bypass graft-
ing (CABG), 30 had percutaneous coronary intervention
(PCI) and the remaining 56 patients were managed
medically. The patient characteristics are detailed in
table 1. All patients undergoing CABG had at least par-
tial viability in the left anterior descending artery terri-
tory. In those who underwent PCI, the results of
viability testing changed the proposed management
strategy in 30%. By the end of the follow period (med-
ian, 28 months), death from any cause occurred in 3
patients (14%) in the CABG group, 4 (13%) in the PCI
group and 14 (25%) in the medical-therapy group
(p=0.32). Hospitalisation for cardiac causes occurred in
1 patient (5%) in the CABG group, 1 (3%) in the PCI
group and 28 (50%) in the medical-therapy group
(p <0.001). Hospitalisation in the medical therapy group
was primarily related to admissions with heart failure (73%).
Conclusions
Patients undergoing surgical revascularisation had signif-
icantly less adverse remodelling than those managed
with PCI or medical therapy. Patients undergoing CABG
with viability prior to revascularisation demonstrated
good outcomes, similar to those undergoing PCI. The
medical therapy group had a significantly higher number
of non-viable segments and outcome was poor. Further
randomised controlled trials using CMR assessment of
viability may provide evidence that viability assessment
is still beneficial prior to revascularisation in patients
with ischaemic cardiomyopathy.
1
Cardiology, Royal Victoria Hospital, Belfast, UK
Full list of author information is available at the end of the article
Cole et al.Journal of Cardiovascular Magnetic
Resonance 2015, 17(Suppl 1):P140
http://www.jcmr-online.com/content/17/S1/P140
© 2015 Cole et al; lic ensee BioMed Central Ltd. Th is is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unr estricted use, distribution, and reproduction in
any medium, pro vided the original work is properly cited. The Creativ e Commons Public Domain Dedication waiver (http://
creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unl ess otherwise stated.
Funding
No external funding.
Authors’details
1
Cardiology, Royal Victoria Hospital, Belfast, UK.
2
Queens University, Belfast,
UK.
3
Antrim Area Hospital, Antrim, UK.
Published: 3 February 2015
doi:10.1186/1532-429X-17-S1-P140
Cite this article as: Cole et al.: The impact of cardiac magnetic
resonance viability assessment on the management of patients with
ischaemic heart disease and left ventricular dysfunction. Journal of
Cardiovascular Magnetic Resonance 2015 17(Suppl 1):P140.
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Table 1 Patient characteristics
CABG (n=22) PCI (n=30) Medical therapy (n=56) P value
Age (yrs) 67.0 ± 9.4 70.5 ± 8.9 69.5 ± 13.0 0.53
Gender (% m) 73 87 86 0.325
LVEF 28.3 ± 4.6 27.4 ± 5.3 25.8 ± 6.0 0.158
LVEDVi (mls/m2) 128.0 ± 29.9 139.8 ± 30.1 139.7 ± 29.5 0.259
LVESVi (mls/m2) 87.3 ± 25.9 101.5 ± 23.6 102.5 ± 25.9 0.049
No. of viable segments 13.1 ± 2.78 12.2 ± 3.0 10.5 ± 3.8 0.005
LVEF- Left Ventricular Ejection Fraction
LVEDVi- Left Ventricular End Diastolic Volume indexed to body surface area
LVESVi- Left Ventricular End Systolic Volume indexed to body surface area
Cole et al.Journal of Cardiovascular Magnetic
Resonance 2015, 17(Suppl 1):P140
http://www.jcmr-online.com/content/17/S1/P140
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