4088Diagnostic specificity of triangular basal inferoseptal late gadolinium enhancement for identification of cardiac sarcoidosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Kuo ◽  
Y.C.,H Yuchi Han ◽  
D M David Mui ◽  
Y Z Ying Zhang ◽  
R S Robert D Schaller ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Ischemic Cardiomyopathy ◽  
Cardiac Sarcoidosis ◽  
Myeloproliferative Neoplasm ◽  
Left Ventricular ◽  
Volume Index ◽  
Gadolinium Enhancement ◽  
Multisystem Disorder ◽  
Imaging Characteristics ◽  
Multiple Imaging

Abstract Background/Introduction Sarcoidosis, a multisystem disorder characterized by infiltration of noncaseating granulomas, can manifest as left ventricular (LV) dysfunction and fatal ventricular arrhythmias. The clinical diagnosis of cardiac sarcoidosis (CS) can be challenging and often requires multiple imaging modalities including cardiac magnetic resonance (CMR). The characterization of unique late gadolinium enhancement (LGE) patterns may assist in the diagnosis on CMR. Purpose We sought to examine the diagnostic value of inferoseptal triangular LGE for CS. Methods The retrospective cohort included 149 non-ischemic cardiomyopathy (NICM) patients referred to our hospital for a CMR from January 2012 to December 2018. Left ventricular LGE was identified in 86 patients (56.4±10.4 years, 84.9% male). Amongst them, 73 patients with septal LGE. We classified the various septal LGE patterns into four categories: (A) Mid-wall septal and basal inferoseptal triangular LGE; (B) Endocardial right ventricular (RV) septal LGE; (C) Basal inferoseptal triangular with endocardial RV septal LGE; (D) Mid-wall septal LGE (Figure). The diagnosis of sarcoidosis was confirmed by the Japanese Circulation Society/Japanese Society of Nuclear Cardiology guidelines. Results Individual diagnoses and imaging characteristics of non-ischemic cardiomyopathy types with septal LGE are summarized in the Table. LV ejection fraction, LV end-diastolic volume index (EDVI) and end-systolic volume index (ESVI) did not significantly differ between sarcoidosis and non-sarcoidosis patients. Pattern A and Pattern B were highly specific but insensitive (Specificity/Sensitivity- A: 98.4/8.3%, p=0.19; B: 95.1%/8.3%, p=0.64) for CS. The only pattern with statistically significantly diagnostic indices was pattern C: specificity of 100% and sensitivity of 58.3% (p<0.001). Pattern D revealed both low specificity of 6.6% and sensitivity of 25% (p<0.001). Imaging characteristics and diagnosis Septal LGE/Diagnosis Sarcoidosis Idiopathic Pulmonary hypertension Giant cell myocarditis Amyloidosis Systemic lupus erythematous Myeloproliferative neoplasm Large cell lymphoma Mid-wall septal and basal inferoseptal triangular LGE 1 1 0 0 0 0 0 0 Endocardial RV septal LGE 1 2 0 1 0 0 0 0 Basal inferoseptal triangular andendocardial RV septal LGE 7 0 0 0 0 0 0 0 Mid-wall septal LGE 3 50 3 0 1 1 1 1 Individual diagnosis and patterns of septal late gadolinium enhancement. Septal LGE patterns Conclusions The presence of basal inferoseptal triangular LGE pattern with endocardial RV involvement enables an accurate diagnosis of CS. The absence of this triangular septal LGE pattern, however, cannot exclude the diagnosis of CS. Acknowledgement/Funding Taipei Veterans General Hospital-National Yang-Ming University Excellent Physician Scientists Cultivation Program, No. 106-V-A-009

scholarly journals Implications of multiple late gadolinium enhancement lesions on the frequency of left ventricular reverse remodeling and prognosis in patients with non‐ischemic cardiomyopathy

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Shingo Ota ◽  
Makoto Orii ◽  
Tsuyoshi Nishiguchi ◽  
Mao Yokoyama ◽  
Ryoko Matsushita ◽  
...  
Keyword(s):  
Heart Failure ◽  
Late Gadolinium Enhancement ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Cardiac Events ◽  
Gadolinium Enhancement ◽  
Systolic Volume ◽  
Linear Pattern ◽  
Multiple Lesions

Abstract Background Non-ischemic cardiomyopathy (NICM) is a heterogeneous disease, and its prognosis varies. Although late gadolinium enhancement (LGE)-cardiovascular magnetic resonance (CMR) demonstrates a linear pattern in the mid-wall of the septum or multiple LGE lesions in patients with NICM, the therapeutic response and prognosis of multiple LGE lesions have not been elucidated. This study aimed to investigate the frequency of left ventricular (LV) reverse remodeling (LVRR) and prognosis in patients with NICM who have multiple LGE lesions. Methods This single-center retrospective study included 101 consecutive patients with NICM who were divided into 3 groups according to LGE-CMR results: patients without LGE (no LGE group = 48 patients), patients with a typical mid-wall LGE pattern (n = 29 patients), and patients with multiple LGE lesions (n = 24 patients). LVRR was defined as an increase in LV ejection fraction (LVEF) ≥ 10 % and a final value of LVEF > 35 %, which was accompanied by a decrease in LV end-systolic volume ≥ 15 % at 12-month follow-up using echocardiography. The frequency of composite cardiac events, defined as sudden cardiac death (SCD), aborted SCD (non-fatal ventricular fibrillation, sustained ventricular tachycardia, or adequate implantable cardioverter-defibrillator therapies), and heart failure death or hospitalization for worsening heart failure, were summarized and compared between the groups. Results Among the 3 groups, the frequency of LVRR was significantly lower in the multiple lesions group than in the no LGE and mid-wall groups (no LGE vs. mid-wall vs. multiple lesions: 49 % vs. 52 % vs. 19 %, p = 0.03). There were 24 composite cardiac events among the patients: 2 in patients without LGE (hospitalization for worsening heart failure; 2), 7 in patients of the mid-wall group (SCD; 1, aborted SCD; 1 and hospitalization for worsening heart failure; 5), and 15 in patients of the multiple lesions group (SCD; 1, aborted SCD; 8 and hospitalization for worsening heart failure; 6). The multiple LGE lesions was an independent predictor of composite cardiac events (hazard ratio: 11.40 [95 % confidence intervals: 1.49−92.01], p = 0.020). Conclusions Patients with multiple LGE lesions have a higher risk of cardiac events and poorer LVRR. The LGE pattern may be useful for an improved risk stratification in patients with NICM.

scholarly journals The Association between the Extent of Late Gadolinium Enhancement and Diastolic Dysfunction in Hypertrophic Cardiomyopathy

2021 ◽  
Author(s):  
Deniz Alis ◽  
Arda Guler ◽  
Ozan Asmakutlu ◽  
Cagdas Topel ◽  
Ahmet A. Sahin
Keyword(s):  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
Diastolic Dysfunction ◽  
Myocardial Fibrosis ◽  
Left Ventricular ◽  
Volume Index ◽  
Gadolinium Enhancement ◽  
Restoring Forces ◽  
The Impact ◽  
The Relationship

Abstract Background Diastolic dysfunction in hypertrophic cardiomyopathy (HCM) patients is a frequent, yet poorly understood phenomenon. Purpose The purpose of this study is to assess the relationship between the myocardial fibrosis and diastolic dysfunction in patients with HCM. Materials and Methods We retrospectively investigated the impact of the myocardial fibrosis, as assessed by the extent of late gadolinium enhancement (LGE-%) on cardiac magnetic resonance imaging (CMRI), on diastolic dysfunction in 110 patients with HCM. The diastolic dysfunction was evaluated by the left atrial (LA) volume index measured on CMRI and lateral septal E/E′ ratio calculated on echocardiography. Results : There was a moderate correlation between the LGE-% and LA volume (r = 0.59, p < 0.0001). The logistic regression model of LGE-%, mitral regurgitation, and total left ventricular mass that investigated the independent predictors of LA volume identified LGE-% as the only independent parameter associated with the LA volume index (β = 0.30, p = 0.003). No correlation was observed between the LGE-% and E/E′(r = 0.24, p = 0.009). Conclusions Myocardial fibrosis in HCM patients is associated with a chronic diastolic burden as represented by increased LA volume. However, the fibrosis does not influence the E/E′ ratio, which is a well-known parameter of ventricular relaxation, restoring forces, and filling pressure.

scholarly journals Effects of candesartan on left ventricular hypertrophy and fibrosis in patients with hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Maqsood ◽  
H.A Shakeel ◽  
H.F Shoukat ◽  
M.D Khan ◽  
S.A.Y Shah ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
Interstitial Fibrosis ◽  
Angiotensin Receptor Blockers ◽  
Left Ventricular ◽  
Funding Source ◽  
Gadolinium Enhancement ◽  
Percent Change ◽  
Lv Mass ◽  
Significant Difference

Abstract Introduction Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular (LV) hypertrophy in the absence of pressure overload. Manifestations of the disease include heart failure associated with diastolic dysfunction and atrial and ventricular tachyarrhythmias. Pathological features of HCM include myocyte hypertrophy, interstitial fibrosis, and myocyte disarray and are mediated by angiotensin II. Purpose This study aimed to evaluate the effects of candesartan on left ventricular (LV) hypertrophy and fibrosis in patients with hypertrophic cardiomyopathy (HCM). Methods In double-blind fashion, 30 patients (6 women, 24 men; age: 55±11 years) with HCM were randomly assigned to receive placebo (n=13) or candesartan 50 mg twice a day (n=17) for 1 year. To measure LV mass and extent of fibrosis, cardiac magnetic resonance imaging was performed at baseline and 1 year as assessed by late gadolinium enhancement. Results There was a trend toward a significant difference in the percent change in LV mass (median: +5% with placebo vs. −5% with candesartan; p=0.06). There was a significant difference in the percent change in the extent of late gadolinium enhancement, with the placebo group experiencing a larger increase (+30±27% with placebo vs. −22±44% with candesartan; p=0.03). Conclusion Our study concludes reduction of the progression of myocardial hypertrophy and fibrosis with candesartan in patients with hypertrophic cardiomyopathy. Our study population was limited so we warrant larger trials to confirm a place for angiotensin receptor blockers in the management of patients with hypertrophic cardiomyopathy. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): Self funding

Cardiac Sarcoidosis Detected by Late Gadolinium Enhancement and Prevalence of Atrial Arrhythmias

2014 ◽  
Vol 113 (9) ◽  
pp. 1556-1560 ◽  
Author(s):  
Matthew A. Cain ◽  
Mark D. Metzl ◽  
Amit R. Patel ◽  
Karima Addetia ◽  
Kirk T. Spencer ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Cardiac Sarcoidosis ◽  
Atrial Arrhythmias ◽  
Gadolinium Enhancement

Abstract 5920: Usefulness of Late Gadolinium Enhancement as Non-invasive Arrhythmic Risk Marker in Patients with Heart Failure and Systolic Dysfunction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Alfonso Valle ◽  
Mercedes Nadal ◽  
Jordi Estornell ◽  
Nieves Martinez ◽  
Miguel Corbi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Late Gadolinium Enhancement ◽  
Risk Stratification ◽  
Systolic Dysfunction ◽  
Total Mortality ◽  
Left Ventricular ◽  
Gadolinium Enhancement ◽  
Non Invasive ◽  
Patients With Heart Failure

The identification of prognostic markers in patients with heart failure of both ischemic and non ischemic etiology is an increasing need in the era of devices therapy. Risk stratification for sudden cardiac death (SCD) remains problematic with reliance on left ventricular function which predicts total mortality rather than arrhythmic events (AE). Recently cardiac magnetic resonance was employed to predict susceptibility for malignant arrhythmias. This study sought to determine the utility of late gadolinium enhancement (LGE) to predict AE. Three hundred consecutive patients with symptomatic heart failure and systolic dysfunction of both ischemic and non ischemic cause undergoing CMR, were classified into two groups attending to the presence (n 160) or absence of LGE (n 140), and were followed prospectively during 842 days. The primary endpoint was the combined of SCD or Ventricular tachycardia (VT). 23 patients had AE (8 SCD/15 VT) during the follow-up, 19 of them presenting LGE (83%). The presence of LGE was associated to a significantly higher AE rate (11.8.% vs 2.8% p< 0.001)(figure ). Compared to patients without LGE, midwall fibrosis and an ischemic pattern of LGE predicted AE. (3% vs 5% vs 14%, p= 0.001) LGE is a new non-invasive predictor of AE in patients with heart failure and systolic dysfunction. This suggest a potential role for risk stratification and better selection of patients who needs device therapy

Abstract 78: Late Gadolinium Enhancement on Cardiac MRI Identifies Ventricular Dysfunction and Regional Myocardial Dyssynchrony in Patients with Univentricular Heart Diseases

2014 ◽  
Vol 115 (suppl_1) ◽  
Author(s):  
Michihiro Okuyama ◽  
Shuta Ishigami ◽  
Daiki Ousaka ◽  
Junko Kobayashi ◽  
Shingo Kasahara ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Myocardial Fibrosis ◽  
Prognostic Value ◽  
Circumferential Strain ◽  
Single Ventricle ◽  
Heart Diseases ◽  
Volume Index ◽  
Univentricular Heart ◽  
Gadolinium Enhancement ◽  
The Impact

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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