DOES GRAY-ZONE LATE GADOLINIUM ENHANCEMENT ENRICH THE PREDICTION OF VENTRICULAR ARRHYTHMIA? A CARDIOVASCULAR MRI STUDY

Background: Late gadolinium enhancement (LGE) by cardiac MR (CMR) has been related to adverse clinical outcomes in patients with nonischemic dilated cardiomyopathy (NIDC). But, a statistically significant association between LGE and arrhythmic risk in NIDC has not been demonstrated consistently. This study evaluated the impact of the presence, location and pattern of LGE on arrhythmic risk prediction in NICM. Methods: This study included 365 patients (54±15years) with NICM who underwent CMR. The extent, location and pattern of LGE were categorized. We analyzed for the primary outcome of ventricular arrhythmia (VA) including sustained or nonsustained ventricular tachycardia (VT), appropriate implantable cardioverter-defibrillator (ICD) intervention and ventricular fibrillation (VF). Cardiac death and hospitalization for heart failure (HF) were evaluated as secondary outcomes. Results: LGE was seen in 267 (73 %) patients. During median follow-up of 44±36 months, patients with LGE had higher incidence of cardiac death (15 % vs. 2 %, p<0.001), hospitalization for HF (40 % vs. 15 %, p<0.001) and VA (14% vs. 6%, p=0.03). In multivariable analysis, the presence of LGE (HR 2.78; 95% CI 1.10-7.02; p=0.03) was the independent predictor of arrhythmias. Patients with extensive LGE had higher VA (32% vs. 10%, p<0.001) with lower cumulative survival free of VA than those without extensive LGE (p=0.001). The frequent LGE location was as follows: LV septum 64%, LV-RV junction 42% and inferior 10%. VA was lower in patients with than without localized LGE limited to LV-RV junction (21% vs. 46%, p=0.005). Interestingly, while the incidence of ventricular arrhythmia was higher in patients with transmural LGE (29% vs. 10%, p=0.003), it was lower in those with patch LGE (2% vs. 16%, p=0.02) than the other patients. Conclusions: In patients with NICM, the LGE was an independent prognostic predictor of VA. Extensive LGE and specific location of LGE was related with the arrhythmic events.

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Late gadolinium enhancement identified with cardiac magnetic resonance imaging in sarcoidosis patients is associated with long-term ventricular arrhythmia and sudden cardiac death

Heart Lung and Circulation ◽

10.1016/j.hlc.2015.06.554 ◽

2015 ◽

Vol 24 ◽

pp. S349

Author(s):

J. Nadel ◽

T. Lancefield ◽

A. Voskoboinik ◽

A. Taylor

Keyword(s):

Magnetic Resonance Imaging ◽

Cardiac Magnetic Resonance ◽

Late Gadolinium Enhancement ◽

Sudden Cardiac Death ◽

Magnetic Resonance ◽

Ventricular Arrhythmia ◽

Cardiac Death ◽

Resonance Imaging ◽

Gadolinium Enhancement

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086 THE DETECTION OF ACUTE MYOCARDITIS USING CARDIOVASCULAR MRI: A CLINICAL STUDY COMPARING T1-MAPPING, T2-WEIGHTED AND LATE GADOLINIUM ENHANCEMENT IMAGING

Heart ◽

10.1136/heartjnl-2013-304019.86 ◽

2013 ◽

Vol 99 (suppl 2) ◽

pp. A53-A54

Author(s):

V Ferreira ◽

S Piechnik ◽

E Dall'Armellina ◽

T Karamitsos ◽

J Francis ◽

...

Keyword(s):

Clinical Study ◽

Late Gadolinium Enhancement ◽

T1 Mapping ◽

Acute Myocarditis ◽

Late Gadolinium Enhancement Imaging ◽

Cardiovascular Mri ◽

Gadolinium Enhancement

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Predictors of subclinical systemic sclerosis primary heart involvement characterised by microvasculopathy and myocardial fibrosis

Rheumatology ◽

10.1093/rheumatology/keaa742 ◽

2020 ◽

Author(s):

Raluca B Dumitru ◽

Lesley-Anne Bissell ◽

Bara Erhayiem ◽

Graham Fent ◽

Ananth Kidambi ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Troponin I ◽

Myocardial Perfusion Reserve ◽

High Sensitivity ◽

Cardiovascular Mri ◽

Gadolinium Enhancement ◽

Perfusion Reserve ◽

High Sensitivity Troponin

Abstract Objectives SSc primary heart involvement (SSc-pHI) is a significant cause of mortality. We aimed to characterize and identify predictors of subclinical SSc-pHI using cardiovascular MRI. Methods A total of 83 SSc patients with no history of cardiovascular disease or pulmonary arterial hypertension and 44 healthy controls (HCs) underwent 3 Tesla contrast-enhanced cardiovascular MRI, including T1 mapping and quantitative stress perfusion. High-sensitivity troponin I and N-terminal pro-brain natriuretic peptide were also measured. Results Cardiovascular MRI revealed a lower myocardial perfusion reserve in the SSc patients compared with HCs {median (interquartile range (IQR)] 1.9 (1.6–2.4) vs 3 (2–3.6), P < 0.001}. Late gadolinium enhancement, indicating focal fibrosis, was observed in 17/83 patients but in none of the HCs, with significantly higher extracellular volume (ECV), suggestive of diffuse fibrosis, in SSc vs HC [mean (s.d.) 31 (4) vs 25 (2), P < 0.001]. Presence of late gadolinium enhancement and higher ECV was associated with skin score [odds ratio (OR) = 1.115, P = 0.048; R2 = 0.353, P = 0.004], and ECV and myocardial perfusion reserve was associated with the presence of digital ulcers at multivariate analysis (R2 = 0.353, P < 0.001; R2 = 0.238, P = 0.011). High-sensitivity troponin I was significantly higher in patients with late gadolinium enhancement, and N-terminal pro-brain natriuretic peptide was associated with ECV (P < 0.05). Conclusion Subclinical SSc-pHI is characterized by myocardial microvasculopathy, diffuse and focal myocardial fibrosis but preserved myocardial contractile function. This subclinical phenotype of SSc-pHI was associated with high-sensitivity troponin I, N-terminal pro-brain natriuretic peptide, SSc disease severity and complicated peripheral vasculopathy. These data provide information regarding the underlying pathophysiological processes and provide a basis for identifying individuals at risk of SSc-pHI.

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P1113Patchy localisation of late gadolinium enhancement associated with ventricular arrhythmia in dilated cardiomyopathy

EP Europace ◽

10.1093/europace/euaa162.043 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

V Pooranachandran ◽

A Mistry ◽

Z Vali ◽

X Li ◽

B Sidhu ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

High Risk ◽

Ventricular Arrhythmia ◽

Dilated Cardiomyopathy ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Lv Function ◽

Gadolinium Enhancement ◽

Ventricular Ejection Fraction ◽

Significant Difference

Abstract Funding Acknowledgements None Introduction Myocardial fibrosis detected using late gadolinium enhancement(LGE) on cardiac magnetic resonance(CMR) imaging holds prognostic value in dilated cardiomyopathy(DCM). Recent reports have demonstrated the localisation of LGE to be promising predictors of ventricular arrhythmic (VA).Aim: To determine the localisation of LGE associated with high risk of VA in DCM patients. Methods: Retrospective review of consecutive DCM patients(n = 85) implanted with an implantable cardioverter defibrillator(ICD) at a single tertiary centre between 2011-2018. All patients with insufficient follow-up data, cardiac channelopathies, primary valvular pathology and congenital heart disease were excluded from analysis(n = 11). Details of VA occurrence were obtained from medical and pacing notes. VA was defined as VA causing haemodynamic compromise or appropriate device therapy (anti-tachycardia pacing/shock). Localisation of LGE was defined as midwall, patchy, subepicardial or transmural. Left ventricular ejection fraction(LVEF) <35% was defined as severely impaired function. Results:74 DCM patients implanted with an ICD were identified for analysis; LGE was observed in 18(60%) VA and 29(66%) non-VA patients(p = 0.6). There was no observed difference in mean age for patients with and without LGE (68 ± 10 vs. 65 ± 10 years,p = 0.07). A significant difference was seen between localisation and VA (p = 0.04), with patchy LGE demonstrating a higher arrhythmic risk(p = 0.005). There was no association between LVEF and LGE(p = 0.2) however, a significant difference was seen in LVEF and arrhythmic risk, with a more severely impaired LV function seen in patients without VA(p = 0.01). Conclusion:This study has demonstrated a patchy LGE localisation to be strongly associated with ventricular arrhythmia in DCM. Whilst this is a valuable tool in risk stratification, a prospective study with a larger population is required to confirm the validity of this finding. Moreover, an additional method will need to be considered to identify high risk patients without LGE. Ventricular Arrhythmia (n = 30) No Ventricular Arrhythmia (n = 44) P Value Male(%) 20(67%) 24(55%) p = 0.29 Age(Mean ± SD) 65 ± 12 65 ± 10 p = 0.36 LGE Midwall 10(56%) 24(83%) p = 0.04 Subepicardial 1(5.5%) 2(7%) p = 0.85 Transmural 1(5.5%) 2(7%) p = 0.85 Patchy 6(33%) 1(3%) p = 0.005 LVEF <35% 23(77%) 42(95%) p = 0.01

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