Role of Late Gadolinium Enhancement in the Assessment of Myocardial Viability.

Dr Viraj Shah,Dr Purnachandra Lamghare,Dr Arunima Gupta,Dr Tushar Kalekar

doi:10.7759/cureus.22844

Abstract

Background: Prior to any revascularization procedure for coronary artery disease, it is essential to identify viable myocardium which will likely benefit from it. In such a situation, delayed enhanced cardiac MRI is beneficial.Methods: Our study consisted of 50 patients with at least a one-month prior history of myocardial infarction (MI), abnormal findings on electrocardiography (ECG), and 2D-echocardiography (2D-ECHO), who were subjected to cardiac MRI performed on a 3T MRI machine. The MRI scans were evaluated for anatomical and especially functional characteristics of the heart, such as wall motion. On late gadolinium enhancement (LGE), the diseased segments were classified into two categories: < 50% LGE (viable) and > 50% LGE (non-viable).Results: Of the 378 diseased segments detected on LGE, 137 (36.2%) segments showed < 50% LGE and 241 (63.8%) segments showed > 50% LGE. The segments showing < 50% LGE showed normokinesia or hypokinesia, with none of the segments showing akinesia or dyskinesia, whereas the segments showing > 50% LGE showed akinesia or dyskinesia predominantly. This was found to be statistically highly significant (p-value < 0.001). Conclusion: Delayed enhanced-cardiac magnetic resonance (DE-CMR) imaging in patients with ischemic heart disease (IHD) helps evaluate the severity of the infarcted myocardium by classifying the diseased myocardium into viable and non-viable, as viable myocardium is more likely to regain functional recovery than non-viable myocardium. It also predicts the functional recovery of the myocardium after revascularization therapy.

Highlights

Cardiovascular disease (CVD) remains the primary cause of mortality worldwide [1]
With the introduction of revascularization techniques such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), observations have been made on their effect on the reversibility of left ventricular (LV) dysfunction [3]
Patients ranging in age from 20 to 80 years were referred from the department of cardiology with at least a one-month prior history of myocardial infarction (MI), ECG findings of either ST-segment elevation myocardial infarction (STEMI) or non-ST segment elevation myocardial infarction (NSTEMI), abnormal 2Dechocardiography (2D-ECHO) findings, and were medically treated with thrombolysis

Summary

Introduction

Cardiovascular disease (CVD) remains the primary cause of mortality worldwide [1]. Indians are affected by CVD at least a decade before the rest of the world [2]. Echocardiography establishes the hypokinetic or akinetic myocardium as diseased. This diseased myocardium may be stunned and hibernating or fibrosed. The viable myocardium is described as hibernating or stunned. Prior to any revascularization procedure for coronary artery disease, it is essential to identify viable myocardium which will likely benefit from it. In such a situation, delayed enhanced cardiac MRI is beneficial

Methods

Results

Discussion

Conclusion