Prognostic Value of Cardiac Magnetic Resonance Septal Late Gadolinium Enhancement Patterns for Periaortic Ventricular Tachycardia Ablation: Heterogeneity of the Anteroseptal Substrate in Nonischemic Cardiomyopathy

Abstract Aims We sought to investigate the overlap between late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) and electro-anatomical maps (EAM) of patients with non-ischaemic dilated cardiomyopathy (NIDCM) and how it relates with the outcomes after catheter ablation of ventricular arrhythmias (VA). Methods and results We identified 50 patients with NIDCM who received CMR and ablation for VA. Late gadolinium enhancement was detected in 16 (32%) patients, mostly in those presenting with sustained ventricular tachycardia (VT): 15 patients. Low-voltage areas (<1.5 mV) were observed in 23 (46%) cases; in 7 (14%) cases without evidence of LGE. Using a threshold of 1.5 mV, a good and partially good agreement between the bipolar EAM and LGE-CMR was observed in only 4 (8%) and 9 (18%) patients, respectively. With further adjustments of EAM to match the LGE, we defined new cut-off limits of median 1.5 and 5 mV for bipolar and unipolar maps, respectively. Most VT exits (12 out of 16 patients) were found in areas with LGE. VT exits were found in segments without LGE in two patients with VT recurrence as well as in two patients without recurrence, P = 0.77. In patients with VT recurrence, the LGE volume was significantly larger than in those without recurrence: 12% ± 5.8% vs. 6.9% ± 3.4%; P = 0.049. Conclusions In NIDCM, the agreement between LGE and bipolar EAM was fairly poor but can be improved with adjustment of the thresholds for EAM according to the amount of LGE. The outcomes were related to the volume of LGE.

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P5554Follow the light - The prognostic value of late gadolinium enhancement in hypertrophic cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehz746.0498 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

F Fortuni ◽

R Abete ◽

C Raineri ◽

S Ghio ◽

F Angelini ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Late Gadolinium Enhancement ◽

Hypertrophic Cardiomyopathy ◽

Magnetic Resonance ◽

Prognostic Value ◽

Phenotypic Expression ◽

Gadolinium Enhancement ◽

Moderator Effect ◽

All Cause Mortality ◽

And Gender

Abstract Background and aim Hypertrophic cardiomyopathy (HCM) is a genetic based cardiomyopathy with heterogeneous phenotypic expression. Since it is one of the most common cause of sudden cardiac death (SCD) in the young different risk score have been proposed to properly identify the patients that would benefit from a primary prevention with an implantable cardioverter-defibrillator (ICD). ESC guidelines on HCM suggest to estimate the risk of SCD considering clinical and echocardiographic parameters and mention the use of cardiac magnetic resonance (CMR) only in the case of poor echo windows. The aim of the present study-level meta-analysis was to explore the prognostic value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for adverse fatal events. Methods We searched PubMed and EMBASE for studies that investigated the prognostic value of LGE in patients with HCM. The outcomes of interest were SCD or aborted SCD, all-cause mortality and cardiovascular (CV) mortality. Random-effects Odds Ratios (ORs) were estimated using a DerSimonian-Laird method with a person-year approach. Moreover, an univariate meta-regression was performed to assess the moderator effect of mean age, LGE % of left ventricle (LV) and gender (expressed as male percentage). Results A total of 7 studies (n=3351) were included in the analysis. Mean follow-up was 3±0.63 years. Mean age was 47.7±14.6 years and 56.9% were male. LGE was detected in 1845 (55%) patients with a mean LGE percentage of LV of 7%. The presence of LGE was associated with an increased incidence of SCD or aborted SCD (OR 3.44; 95% CI 2.02–5.86; p<0.001- Figure), all-cause mortality (OR 1.92; 95% CI 1.31–2.81; p<0.001) and CV mortality (OR 3.16; 95% CI 1.77–5.64; p<0.001) compared with the absence of LGE at CMR. The LGE percentage of LV, mean age and gender did not have any moderator effect on the outcomes of interest. However, LGE % of LV was reported only in 4 studies and the absence of any moderator effect of this parameter could be due to a type II error. Prognostic value of LGE for SCD Conclusions The presence of LGE at CMR in patients with HCM exhibited a substantial prognostic value in fatal events and, in particular, in the prediction of SCD. LGE assessment is an effective tool to stratify the arrhythmic risk in HCM. Therefore, it should be considered, especially in borderline cases, to improve the identification of HCM patients who could benefit from ICD implantation.

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Late Gadolinium Enhancement on Cardiac Magnetic Resonance Images Predicts Reverse Remodeling in Patients with Nonischemic Cardiomyopathy Treated with Beta Blockers

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2011.06.642 ◽

2011 ◽

Vol 17 (9) ◽

pp. S143

Author(s):

Keisuke Kida ◽

Yasuyuki Kobayashi ◽

Kihei Yoneyama ◽

Makoto Takano ◽

Norio Suzuki ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Late Gadolinium Enhancement ◽

Magnetic Resonance ◽

Beta Blockers ◽

Magnetic Resonance Images ◽

Reverse Remodeling ◽

Nonischemic Cardiomyopathy ◽

Gadolinium Enhancement

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Prognostic Value of Adenosine Stress Perfusion Cardiac Magnetic Resonance with Late Gadolinium Enhancement in Intermediate Cardiovascular Risk Patients

Heart Lung and Circulation ◽

10.1016/j.hlc.2011.05.463 ◽

2011 ◽

Vol 20 ◽

pp. S187-S188

Author(s):

A. Bertaso ◽

J. Richardson ◽

A. Nelson ◽

D. Wong ◽

H. Tayeb ◽

...

Keyword(s):

Cardiovascular Risk ◽

Cardiac Magnetic Resonance ◽

Late Gadolinium Enhancement ◽

Magnetic Resonance ◽

Prognostic Value ◽

Adenosine Stress ◽

Stress Perfusion ◽

Gadolinium Enhancement ◽

Risk Patients ◽

Adenosine Stress Perfusion

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Association of Late Gadolinium Enhancement and Degree of Left Ventricular Hypertrophy Assessed on Cardiac Magnetic Resonance Imaging With Ventricular Tachycardia in Children With Hypertrophic Cardiomyopathy

The American Journal of Cardiology ◽

10.1016/j.amjcard.2016.01.032 ◽

2016 ◽

Vol 117 (8) ◽

pp. 1342-1348 ◽

Cited By ~ 6

Author(s):

Joseph A. Spinner ◽

Cory V. Noel ◽

Susan W. Denfield ◽

Rajesh Krishnamurthy ◽

Aamir Jeewa ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ventricular Tachycardia ◽

Cardiac Magnetic Resonance ◽

Late Gadolinium Enhancement ◽

Hypertrophic Cardiomyopathy ◽

Magnetic Resonance ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Resonance Imaging ◽

Gadolinium Enhancement

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Abstract 12145: Cardiac Magnetic Resonance Late Gadolinium Enhancement is Associated With Ventricular Elastance That May Predict Latent Ventricular Dysfunction After Fontan Procedure

Circulation ◽

10.1161/circ.130.suppl_2.12145 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Michihiro Okuyama ◽

Shuta Ishigami ◽

Daiki Ousaka ◽

Junko Kobayashi ◽

Sadahiko Arai ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Late Gadolinium Enhancement ◽

Magnetic Resonance ◽

Prognostic Value ◽

Circumferential Strain ◽

Fontan Procedure ◽

Volume Index ◽

Gadolinium Enhancement ◽

Global Circumferential Strain ◽

Ventricular Elastance

Backgrounds: Systemic right ventricular circulation after Fontan procedures is known to have late hemodynamic complications. Although a number of studies have investigated the factors that may impact on survival, postoperative outcomes after palliations remain to be elucidated. Objective: The purpose of this study is to investigate the prognostic value of myocardial fibrosis identified by cardiac magnetic resonance imaging (cMRI) in patients with single ventricular physiology. Methods: Consecutive 23 patients undergoing Fontan procedures were prospectively scheduled to have cMRI study with late gadolinium enhancement (LGE) imaging and ventricle circumferential strain measurement before and 4 months after Fontan operation. Results: Of 23 patients (mean age 3.3±0.9 years), 7 were positive for LGE (LGE+) and median percent LGE was 3.0% (interquartile range 3.0% to 7.5%). Pre-Fontan examinations revealed that patients with LGE+ showed an increase in end-diastolic volume index (139.7±26.8 ml/BSA vs. 113.3±20.9 ml/BSA; P=0.02) and end-systolic volume index (ESVI: 99.9±32.2 ml/BSA vs. 70.8±20.0 ml/BSA; P=0.01) compared with those without LGE (LGE-). In contrast to LGE- group, LGE+ patients showed lower global circumferential strain (4.1±2.3% vs. 7.9±2.7%, P=0.006), decreased ejection fraction (EF: 29±9.1% vs. 38±8.7%; P=0.04), and reduced end-systolic elastance (1.1±0.3 mm Hg/ml/m2 vs. 1.7±0.5 mm Hg/ml/m2). In addition, LGE+ group had higher levels of BNP (91.0±72.4 pg/ml vs. 30.9±44.0 pg/ml, P=0.02) and New York University Pediatric Heart Failure Index (10.9±3.3 vs. 7.8±1.1, P=0.02) than LGE- group. This was validated by positive correlations between the area of LGE versus ESVI (r=0.85, P=0.01) and BNP levels (r=0.82, P=0.02), respectively. At 4 months after Fontan procedure, LGE- group showed higher EF (37.5±8.6% vs. 24.0±8.9%, P=0.02) compared with those in LGE+ patients, and increased global circumferential strain (6.5±2.0% to 7.4±2.7%, P=0.04). Conclusion: LGE identified by cMRI before operation may be associated with lower ventricular elastance that resulted in poorer functional recovery after staged palliation. This novel strategy may provide a prognostic value of latent myocardial dysfunction after Fontan procedure.

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