The Prognostic Value of Late Gadolinium Enhancement in Nonischemic Heart Disease

Backgrounds: The impact of myocardial fibrosis on cardiac performance and clinical outcomes in patients with a functional single ventricle before stage-3 operation is unknown. 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 univentricular heart diseases. Methods: Consecutive 23 patients undergoing staged-3 surgical palliation with single ventricle physiology were prospectively scheduled to have cMRI study with late gadolinium enhancement (LGE) imaging and ventricle circumferential strain were examined. Results: Of 23 patients (mean age 3.3±0.9 years), 6 (26%) had positive late gadolinium enhancement (LGE+) in the ventricular myocardium, median percent LGE was 3.0% (interquartile range 3.0% to 14.0%). Pre-Fontan examinations revealed that patients with LGE+ had increased end-diastolic volume index (142.8 ml/BSA vs. 113.8 ml/BSA; P=0.02), increased end-systolic volume index (101.0 ml/BSA vs. 72.2 ml/BSA); P=0.01) compared with those without LGE (LGE-). Patients with LGE have shown to have lower ventricular circumferential strain compared with the area without LGE (basal: −1.9±1.9% vs. −4.0±3.0%, P=0.046; mid: −3.9±2.1% vs −8.0±3.9%, P=0.007; apical: −3.9±2.4% vs. −8.2±2.8%, P=0.004). In contrast to LGE- group, patients in LGE+ group had decreased right ventricular ejection fraction (27.7±8.8% vs. 38.2±8.4%; P=0.02) as well as higher levels of BNP (99.2±75.7 pg/ml vs. 32.6±44.3 pg/ml, P=0.02). In addition, patients with LGE+ had higher score of Ross classification (2.5±0.55 vs. 2.0±0, P=0.02) and New York University Pediatric Heart Failure Index (11.0±3.5 vs. 7.8±1.1, P=0.01) than in LGE- group. Age at stage-2 palliation was significantly older in patients with LGE+ group than LGE- subjects (16.8±16 months vs. 8.8±3.4 months, P=0.03). Conclusion: In this pre-stage-3 cMRI study, the age to stage-2 palliation may attribute to substantial myocardial fibrosis. The area of LGE was associated with impaired regional circumferential strain as well as disturbed ventricular performance. This novel strategy may provide a possible prognostic value of latent myocardial dysfunction after staged palliation.

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Abstract 10958: Identification of Right Ventricular Myocardial Infarction With Late Gadolinium Enhancement in Chronic Ischemic Heart Disease: Comparison With Pathological Findings

Circulation ◽

10.1161/circ.132.suppl_3.10958 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Yan Chaowu ◽

Li Li ◽

Fang Wei ◽

Li Hua ◽

Wang Yang

Keyword(s):

Myocardial Infarction ◽

Heart Disease ◽

Late Gadolinium Enhancement ◽

Ischemic Heart Disease ◽

Ischemic Heart ◽

Pathological Findings ◽

Chronic Ischemic Heart Disease ◽

Gadolinium Enhancement ◽

Right Ventricular Myocardial Infarction ◽

Replacement Fibrosis

Introduction: Late gadolinium enhancement (LGE) has the potential to become an excellent technique in the diagnosis of right ventricular myocardial infarction (RVMI). However, the gold standard, pathological findings from patients, is still unavailable to validate the true value of LGE. Hypothesis: We hypothesized that LGE might correspond with histological infarction in RVMI. Methods: 36 transplant candidates (35 M /1F) with chronic ischemic heart disease were studied prospectively with LGE. According to the 12-segment-model, the pathological findings of RV were compared with the previous in vivo LGE after heart transplantation. Results: Histological RVMI was detected in 7 patients, and corresponded with all LGE segments (n=23) and 2 non-LGE segments. A generalize linear mix effect model showed non-significant difference (P=0.152) between the results of LGE and histological infraction. In identifying the RV segments with histological infarction, sensitivity and specificity of LGE was 92.0% (95%CI 74.0% to 99.0%) and 100% (95%CI 99.9% to 100.0%), respectively. Furthermore, RV segments without LGE mainly included two pathological patterns: histologically normal myocardium (n=372) or the admixture of viable myocardium and scattered replacement fibrosis (n=35). In the non-LGE RV segments, wall motion abnormality was associated with volume fraction of collagen (11.4±6.5% vs 4.3±2.2%, P<0.001) and the presence of ischemia (96.4% vs 1.7%, P<0.001). Conclusions: The RV segments with LGE corresponded closely with histological infarction in ischemic heart disease. However, RV segments without LGE might be histologically normal myocardium or intermixed with scattered replacement fibrosis. Further studies are required to evaluate the significance of scattered replacement fibrosis in the non-LGE segments.

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Prevalence and prognostic value of late gadolinium enhancement on CMR in aortic stenosis: meta-analysis

European Radiology ◽

10.1007/s00330-019-06386-3 ◽

2019 ◽

Vol 30 (1) ◽

pp. 640-651 ◽

Cited By ~ 4

Author(s):

Giedre Balciunaite ◽

Viktor Skorniakov ◽

Arnas Rimkus ◽

Tomas Zaremba ◽

Darius Palionis ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Aortic Stenosis ◽

Prognostic Value ◽

Meta Analysis ◽

Gadolinium Enhancement

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Cardiac MRI utilizing late gadolinium enhancement (LGE) and T1 mapping in the detection of radiation induced heart disease

Cardio-Oncology ◽

10.1186/s40959-020-00061-z ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Anthony Ricco ◽

Alexander Slade ◽

Justin M. Canada ◽

John Grizzard ◽

Franklin Dana ◽

...

Keyword(s):

Heart Disease ◽

Late Gadolinium Enhancement ◽

Cardiac Mri ◽

T1 Mapping ◽

Gadolinium Enhancement ◽

Radiation Induced

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Correction to: Prevalence and prognostic value of late gadolinium enhancement on CMR in aortic stenosis: meta-analysis

European Radiology ◽

10.1007/s00330-020-06818-5 ◽

2020 ◽

Vol 30 (9) ◽

pp. 5222-5222 ◽

Cited By ~ 1

Author(s):

Giedre Balciunaite ◽

Viktor Skorniakov ◽

Arnas Rimkus ◽

Tomas Zaremba ◽

Darius Palionis ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Aortic Stenosis ◽

Prognostic Value ◽

Meta Analysis ◽

Gadolinium Enhancement

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Long-term prognostic value of late gadolinium enhancement in a cohort of patients with nonischemic dilated cardiomyopathy

International Journal of Cardiology ◽

10.1016/j.ijcard.2014.09.110 ◽

2014 ◽

Vol 177 (1) ◽

pp. 17-19 ◽

Cited By ~ 7

Author(s):

Jorge Rodríguez-Capitán ◽

José Manuel García-Pinilla ◽

Isabel Ruiz-Zamora ◽

Eloy Rueda-Calle ◽

Luis Morcillo-Hidalgo ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Dilated Cardiomyopathy ◽

Prognostic Value ◽

Gadolinium Enhancement ◽

Nonischemic Dilated Cardiomyopathy

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Use of cardiovascular magnetic resonance for risk stratification in chronic heart failure: prognostic value of late gadolinium enhancement in patients with non-ischaemic dilated cardiomyopathy

Heart ◽

10.1136/hrt.2010.205542 ◽

2010 ◽

Vol 97 (9) ◽

pp. 727-732 ◽

Cited By ~ 141

Author(s):

S. Lehrke ◽

D. Lossnitzer ◽

M. Schob ◽

H. Steen ◽

C. Merten ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Magnetic Resonance ◽

Late Gadolinium Enhancement ◽

Magnetic Resonance ◽

Chronic Heart Failure ◽

Risk Stratification ◽

Dilated Cardiomyopathy ◽

Prognostic Value ◽

Gadolinium Enhancement

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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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