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Acute coronary syndromes may appear and develop in a silent way. These patients may not receive adequate therapy, and thus are more prone to short and long-term complications. Our objective was to assess the prevalence of silent necrosis in our cohort of patients submitted to a late gadolinium enhancement cardiac magnetic resonance scan (LGE-CMR) in our unit.Methods: All patients submitted to a LGE-CMR in our unit, and no known previous history of acute coronary syndrome, were included. The CMR protocol included, in all patients, TrueFISP cine sequences in the usual views and late gadolinium enhancement sequences. In a percentage of cases myocardial perfusion sequences after administration of iv dipyridamole (0.4mg/Kg) were also acquired.Results: 1342 patients with no known previous history of acute coronary syndrome were recruited (755 males, 62±14yrs). Reasons for referral were: 71.5% to rule out coronary artery disease (CAD), 12.4% for study of dilated cardiomyopathy (DCM), 3.7% for arrhythmogenic right ventricular cardiomyopathy, 2.6% valvular heart disease, 5.8% to rule out myocarditis, and 4% for other reasons. Of them, 165 (132 males, 66±11yrs), representing 12.3% of the whole group, showed myocardial necrosis. Patients with silent necrosis were older (p<0.001) and more frequently males (p<0.001). 20% of patients studied to rule out CAD and 12.4% of those studied for DCM had necrosis. None of the patients with suspicion of myocarditis had necrosis. Necrosis extension was usually small: necrotic mass 7.9±9.4gr, percentage of necrotic to total myocardium 4.2±4.6% and number of affected segments 2.8±2.1. Nonetheless, in 17 patients (10.3%) percentage of necrotic myocardium was >10% and in 20 patients (12%) the number of affected segments was >5. In 71% of cases necrosis was subendocardial, in 12% transmural and in 17% both patterns coexisted. After adjustment for age, gender and reason for referral, patients with silent necrosis were shown to have worse systolic function (left ventricular ejection fraction: 62±1 vs 54±3%, P<0,01) and ventricular remodeling.Conclusions: In this descriptive study of our series of patients referred for CMR, with no known previous history of acute coronary syndrome, prevalence of silent necrosis was 12.3%. Though in the majority of cases necrosis was small, systolic function was worse in patients with necrosis. Detection of silent necrosis is important in order to provide adequate therapy and improve prognosis.