Prognostic value of unrecognised myocardial infarction detected by late gadolinium-enhanced MRI in diabetic patients with normal global and regional left ventricular systolic function

Abstract

Objectives: To determine whether the detection of unrecognised myocardial infarction (MI) using late gadolinium-enhanced (LGE)-magnetic resonance imaging (MRI) can provide prognostic information in diabetic patients with normal ECG as well as normal global and regional left ventricular (LV) function.

Methods: From 449 diabetic patients who had complete cine- and LGE-MRI, 321 patients with histories of CAD, ischaemic ECG changes and abnormal cine MRI findings (LV ejection fraction <50 % or presence of regional wall motion abnormality) were excluded. The presence and extent of LGE were determined in the remaining 128 patients. Follow-up information was obtained for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death, acute MI, heart failure, unstable angina and significant ventricular arrhythmias in 120 patients.

Results: Of 120 patients, 18 (15 %) had LGE. During follow-up (median, 27 months), six patients with LGE (33.3 %) and four patients without LGE (3.9 %) experienced MACE, resulting in an annualised event rate of 7.7 % and 0.9 %, respectively (log-rank P <0.001). The presence of LGE was associated with an eight-fold increased hazard for MACE (HR, 8.84; P = 0.001).

Conclusions: LGE-MRI can detect unrecognised MI and may improve the risk stratification of diabetic patients with no CAD history, normal ECG and normal LV systolic function.

Key points: • Late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) can identify subtle myocardial abnormalities. • LGE-MRI can detect myocardial infarction missed by ECG and cine-MRI. • Unrecognised MI detected by LGE-MRI was associated with adverse cardiac events. • LGE-MRI helps clinicians to assess diabetic patients with unrecognised MI.