Unrecognized myocardial scar by late-gadolinium-enhancement cardiovascular magnetic resonance: Insights from the population-based Hamburg City Health Study

J Cardiovasc Magn Reson. 2024 Summer;26(1):101008. doi: 10.1016/j.jocmr.2024.101008. Epub 2024 Feb 9.

Abstract

Background: The presence of myocardial scar is associated with poor prognosis in several underlying diseases. Late-gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging reveals clinically silent "unrecognized myocardial scar" (UMS), but the etiology of UMS often remains unclear. This population-based CMR study evaluated prevalence, localization, patterns, and risk factors of UMS.

Methods: The study population consisted of 1064 consecutive Hamburg City Health Study participants without a history of coronary heart disease or myocarditis. UMS was assessed by standard-phase-sensitive-inversion-recovery LGE CMR.

Results: Median age was 66 [quartiles 59, 71] years and 37% (388/1064) were females. UMS was detected in 244 (23%) participants. Twenty-five participants (10%) had ischemic, and 217 participants (89%) had non-ischemic scar patterns, predominantly involving the basal inferolateral left-ventricular (LV) myocardium (75%). Two participants (1%) had coincident ischemic and non-ischemic scar. The presence of any UMS was independently associated with LV ejection fraction (odds ratios (OR) per standard deviation (SD) 0.77 (confidence interval (CI) 0.65-0.90), p = 0.002) and LV mass (OR per SD 1.54 (CI 1.31-1.82), p < 0.001). Ischemic UMS was independently associated with LV ejection fraction (OR per SD 0.58 (CI 0.39-0.86), p = 0.007), LV mass (OR per SD 1.74 (CI 1.25-2.45), p = 0.001), and diabetes (OR 4.91 (CI 1.66-13.03), p = 0.002). Non-ischemic UMS was only independently associated with LV mass (OR per SD 1.44 (CI 1.24-1.69), p < 0.001).

Conclusion: UMS, in particular with a non-ischemic pattern, is frequent in individuals without known cardiac disease and predominantly involves the basal inferolateral LV myocardium. Presence of UMS is independently associated with a lower LVEF, a higher LV mass, and a history of diabetes.

Trial registration: ClinicalTrials.gov NCT03934957.

Keywords: Cardiovascular magnetic resonance; Ischemic scar; Late-gadolinium-enhancement; Non-ischemic scar; Population-based study; Unrecognized myocardial scar.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Asymptomatic Diseases
  • Cardiomyopathies / diagnostic imaging
  • Cardiomyopathies / pathology
  • Cardiomyopathies / physiopathology
  • Cicatrix* / diagnostic imaging
  • Cicatrix* / etiology
  • Cicatrix* / pathology
  • Cicatrix* / physiopathology
  • Contrast Media* / administration & dosage
  • Cross-Sectional Studies
  • Female
  • Germany / epidemiology
  • Humans
  • Magnetic Resonance Imaging, Cine*
  • Male
  • Middle Aged
  • Myocardial Ischemia / diagnostic imaging
  • Myocardial Ischemia / physiopathology
  • Myocardium* / pathology
  • Organometallic Compounds / administration & dosage
  • Predictive Value of Tests*
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Stroke Volume*
  • Ventricular Function, Left*

Substances

  • Contrast Media
  • Organometallic Compounds

Associated data

  • ClinicalTrials.gov/NCT03934957