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.

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

scholarly journals 332 Clinical and prognostic significance of junctional late gadolinium enhancement in patients with non-ischaemic cardiomyopathy

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Laura De Michieli ◽  
Manuel De Lazzari ◽  
Giorgio Porcelli ◽  
Alberto Cipriani ◽  
Matteo Dalla Libera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Late Gadolinium Enhancement ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Control Group ◽  
Significant Determinant ◽  
Gadolinium Enhancement ◽  
Hemodynamic Profile

Abstract Aims Pulmonary hypertension (PH) carries a poor prognosis in patients with non-ischaemic dilated cardiomyopathy (NIDC). Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) evaluation can identify myocardial abnormalities. In particular, junctional LGE is already an established marker of adverse right ventricular (RV) remodelling in patients with pre-capillary PH. This study sought to assess the prevalence of junctional LGE by CMR in NIDC, its relationship with hemodynamic parameters and, moreover, its prognostic significance. Methods and results Patients with NIDC who underwent right heart catheterization (RHC) and CMR within 3 months in a tertiary hospital were enrolled. Patients with acute heart failure were excluded. Among others, RV and left ventricular (LV) volumes, junctional LGE at CMR, pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP) at RHC were tabulated. Pulmonary hypertension was defined accordingly to current Guidelines (median PAP at RHC ≥ 25 mmHg). The primary endpoint consisted of heart failure (HF) hospitalization during follow-up. A total of 188 patients [median age 49 (SD 15), 71% males] were evaluated. At morpho-functional CMR evaluation, most subjects (76%) had important systolic dysfunction (LV EF ≤ 35%). Junctional LGE was observed in 83 (44%) patients. Among patients with junctional LGE, 21 had LGE confined only to the junctional region, while 61 had also mid-wall interventricular septal stria and 21 a mid-wall stria in the lateral free LV wall. Patients with junctional LGE had lower RV EF (49% vs. 56%, P &lt; 0.001) and LV EF (27% vs. 30%, P = 0.012) when compared to those without junctional LGE although no differences in LV and RV dimensions were found. RHC showed PH in 83 patients (44%). Patients with junctional LGE showed a worse hemodynamic profile in terms of PH (55% vs. 36%; P = 0.011) and increase in PCWP (PCWP &gt; 15 mmHg in 60% vs. 42%; P = 0.015) compared to subjects without junctional LGE. Among 79 patients with PH and PCWP &gt; 15 mmHg, 75 (95%) had a combined post capillary and pre-capillary PH (diastolic pressure gradient ≥7 mmHg). Univariate analysis showed that junctional LGE was associated with a worse hemodynamic profile; on multivariable model, RV EF was significantly associated with the presence of junctional LGE (OR: 0.91; 95% CI: 0.87–0.96, P &lt; 0.001). During a median follow-up of 58 months, 33 patients (18%) died or underwent heart transplantation/ventricular assist device implantation, 17% in the junctional LGE group vs. 18% among those without junctional LGE. Thirty-eight patients (20%) had at least one episode of HF, 22 among junctional LGE group and 16 in control group (27% vs. 15%, P = 0.056). When adjusted for age, junctional LGE resulted a significant determinant of HF hospitalization (OR: 2.13, 95% CI: 1.02–4.44, P = 0.044). Conclusions Junctional LGE is detectable in almost half of NIDC patients and it is related to a worse haemodynamic profile, characterized by PH and elevated PCWP. Moreover, after adjustment for age, it was a significant determinant of HF hospitalization during follow-up in our population. Junctional LGE can therefore represent a useful prognostic tool, as marker of adverse ventricular remodelling likely related to ventricular interdependence.

scholarly journals Characterizing Heart Failure in the Ventricular Volume Domain

2015 ◽  
Vol 9s1 ◽  
pp. CMC.S18744 ◽  
Author(s):  
Peter L. M. Kerkhof
Keyword(s):  
Heart Failure ◽  
Graphical Representation ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume ◽  
Lv Volume

Heart failure (HF) may be accompanied by considerable alterations of left ventricular (LV) volume, depending on the particular phenotype. Two major types of HF have been identified, although heterogeneity within each category may be considerable. All variants of HF show substantially elevated LV filling pressures, which tend to induce changes in LV size and shape. Yet, one type of HF is characterized by near-normal values for LV end-diastolic volume (EDV) and even a smaller end-systolic volume (ESV) than in matched groups of persons without cardiac disease. Furthermore, accumulating evidence indicates that, both in terms of shape and size, in men and women, the heart reacts differently to adaptive stimuli as well as to certain pharmacological interventions. Adjustments of ESV and EDV such as in HF patients are associated with (reverse) remodeling mechanisms. Therefore, it is logical to analyze HF subtypes in a graphical representation that relates ESV to EDV. Following this route, one may expect that the two major phenotypes of HF are identified as distinct entities localized in different areas of the LV volume domain. The precise coordinates of this position imply unique characteristics in terms of the actual operating point for LV volume regulation. Evidently, ejection fraction (EF; equal to 1 minus the ratio of ESV and EDV) carries little information within the LV volume representation. Thus far, classification of HF is based on information regarding EF combined with EDV. Our analysis shows that ESV in the two HF groups follows different patterns in dependency of EDV. This observation suggests that a superior HF classification system should primarily be founded on information embodied by ESV.

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

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