CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 134 AFRICA Regarding the left ventricular systolic function assessed by LVEF, there was an inverse relationship between the LVEF and event severity in the ICM group (p = 0.013, rs = –0.263) (Fig. 3). This was different from the results of the NICM group where there was no significant correlation between the LVEF and event severity (p = 0.128, rs = 0.180). Discussion Many of the recent research studies concerned with myocardial scar were designed to assess the presence or absence of this scar and its relationship with sudden cardiac arrest and/or malignant ventricular arrhythmias, hence the indication for implantable cardioverter–defibrillator (ICD) insertion, paying less attention to the rest of the clinical spectrum of the outcome.8 In our study, we were not only interested in sudden cardiac arrest as the main outcome. The wider spectrum of clinical events is thought to provide more data on expected clinical pattern, hence, treatment plans and expected quality of life in cardiomyopathy patients. A linear relationship was clearly observed between the size of the myocardial scar (using any of the three methods) and the severity of the clinical event. More serious cardiac events such as hospitalisation due to heart failure, serious arrhythmias and Table 1. Analysis of scar mass, actual number of scar segments, percentage of scar and LVEF in groups I and II Event Scar mass (g), mean ± SD Number of scar segments, mean ± SD Percentage of scar, mean ± SD LVEF (%), mean ± SD Total* Group I* Group II* Total* Group I* Group II* Total* Group I* Group II* Total Group I* Group II No events 0.3 ± 0.4 0.4 ± 0.4 0.2 ± 0.3 0.5 ± 0.7 0.8 ± 0.8 0.3 ± 0.7 1.5 ± 2.1 2.5 ± 2.2 0.9 ± 2.0 52.4 ± 14.6 62.2 ± 8.6 46.5 ± 14.5 Chest pain 0.9 ± 0.8 1.3 ± 0.7 0.2 ± 0.4 1.3 ± 1.1 1.7 ± 0.9 0.3 ± 0.7 5.4 ± 4.7 7.4 ± 4.2 1.0 ± 2.1 59 ± 10.5 61.8 ± 8.1 53.0 ± 13 Heart failure 1.4 ± 1.9 2.0 ± 1.8 0.8 ± 1.8 2.1± 2.2 2.6 ± 1.7 1.6 ± 2.7 8.4 ± 11.0 11.8 ± 10.6 4.8 ± 10.7 46.1 ± 13.1 51.3 ± 13 40.5 ± 11 Hospitalisation 4.1 ± 3.0 4.7 ± 2.9 2.8 ± 3 5.5 ± 3.5 5.9 ± 2.7 4.8 ± 4.7 23.9 ±17.8 27.9 ± 16.9 16.6 ± 17.7 44.4 ± 14.9 41.8 ± 12.9 49.1 ± 17.3 Syncope 1.4 ± 1.2 1.9 ± 1.1 1.0 ± 1.2 2.5 ± 1.9 3.1 ± 1.10 2.1 ± 1.9 8.2 ± 7.2 11.3 ± 6.6 5.9 ± 7.2 51.6 ± 19.3 54.8 ± 15.8 49.3 ± 22.3 Ventricular tachycardia 1.7 ± 1.3 1.6 ± 1.2 1.8 ± 1.5 2.4 ± 1.7 2.2 ± 1.3 2.6 ± 2.2 9.8 ± 7.5 9.4 ± 7.3 10.3 ± 8.8 49.7 ± 16.2 53.6 ± 10.5 44.8 ± 22.3 Arrest 2.7 ± 1.8 3.3 ± 1.8 1.9 ± 1.8 3.3± 1.7 3.8 ± 1.5 2.5 ± 1.9 15.9 ± 10.8 19.1 ± 10.8 11.0 ± 10.3 60.9 ± 10.5 58.7 ± 13.3 64.3 ± 4.0 *Statistical significance with event severity. 90 80 70 60 50 40 30 20 10 0 Scar mass Event severity 1 2 3 4 5 6 7 rs = 0.464* p < 0.001* 120 100 80 60 40 20 0 Scar mass Event severity 1 2 3 4 5 6 7 rs = 0.542* p < 0.001* 100 80 60 40 20 0 Scar mass Asympt CP HF HA Syncope VT Arrest Event 120 100 80 60 40 20 0 Scar mass Asympt CP HF HA Syncope VT Arrest Event * * * * * * Fig. 1. Relationship between event severity and scar mass; A and C for group I, and B and D for group II. Asympt, asymptomatic; CP, chest pain; HF, heart failure; HA, hospitalisation; VT, ventricular tachycardia. A C B D
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