Left Ventricular Late Gadolinium Enhancement Research Articles

The Concordance Rates between LV Hypertrophy and RV Hypertrophy in Patients with Hypertrophic Cardiomyopathy as Diagnosed by Cardiovascular MRI with Fibrosis Imaging

Introduction: CMR has become the leading modality to define the clinical impact of hypertrophic cardiomyopathy (HCM). Late gadolinium enhancement (LGE) accurately identifies regions of myocardial fibrosis. It is well known that myocardial fibrosis can occur in patients with HCM and is independently linked to a poorer prognosis than those without fibrosis by CMR. Hypothesis: We hypothesize that there is significant RV involvement in HCM when incorporates a CMR analysis for RV hypertrophy and fibrosis. Methods: A retrospective review of all patients referred for HCM was performed. SSFP/LGE techniques were used to diagnose patients with HCM, using gadolinium administration (0.15 mmol/kg). Post-injection (10 minutes) LGE images were obtained using manual T1-weighted, IR-preparations. Regions of myocardium with LGE signals were visually designated as fibrotic. LV/RV mass indices (LVMI/RVMI) and ejection fractions were calculated. Results: Via 72 patients referred for HCM, 47(65%) were CMR confirmed. The mean LVMI was 108 ± 44 g/m2 while the mean RVMI was 30 ± 21 g/m2. As well, 34/47 (72%) had evidence of LV fibrosis while 24/47 (51%) had evidence for RV fibrosis. Of the RVH positive patients, 26/34 (76%) patients were LV LGE positive and 18/34 (52%) were RV LGE positive. Conclusion: The high frequency of RVH and RV fibrosis in the setting of HCM is surprising in that this phenomenon is rarely described. However, there is no reason to expect the phenotypic expression should be limited to the LV. Interestingly, as for the LV, the presence or absence of RV fibrosis has little predictive power towards the systolic function.

Late gadolinium enhancement on CMR and sustained ventricular tachycardia predict severe cardiac infl ammation

Objective Early diagnosis of severe inflammatory forms of non-ischaemic cardiomyopathy (NICM), e.g. cardiac sarcoidosis (CS) or giant cell myocarditis (GCM), may enable unique treatment. However, there is limited information on how to identify CS or GCM in unselected patients with suspected NICM. We studied the clinical and imaging predictors of severe cardiac inflammation at the era of late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR).Methods and results In this observational cohort study, we enrolled 86 consecutive patients referred for LGE-CMR due to suspected NICM. Patients were extensively examined for underlying aetiology and followed up for at least two years to assure the final diagnosis. Ischaemic cardiomyopathy was excluded. During follow-up, 11 (13%) patients were diagnosed with CS (n = 8) or GCM (n = 3). At baseline, sustained ventricular tachycardia (OR = 20.8, P= 0.001) and the volume of left ventricular LGE (OR = 1.06 for each 1% increase in LGE, P= 0.001) were significant adjusted predictors of CS or GCM. Palpitation, a disease course less than 3 months, septal abnormality in echocardiography, reduced stroke volume and atrioventricular block were other unadjusted predictors of CS or GCM. Multifocal LGE, affecting several myocardial layers and not confined to coronary artery perfusion territories, was useful in identifying CS or GCM, with 52-fold unadjusted OR (P <0.001), sensitivity of 91% and specificity of 84%. In addition, positron emission tomography detected mediastinal lymph node biopsy targets in CS.Conclusions In consecutive patients suspected for NICM, LGE volume and sustained ventricular tachycardia predict independently CS or GCM. Multifocal LGE is useful in identifying severe cardiac inflammation.

CMR-DETERMINED LV DIASTOLIC DYSFUNCTION IN DIABETIC PATIENTS IS ASSOCIATED WITH INCREASED MYOCARDIAL EXTRACELLULAR VOLUME FRACTION

Diabetic myocardial changes include increased myocardial apoptosis, necrosis, collagen deposition and interstitial fibrosis. These may result in myocardial stiffness and alteration of myocardial extracellular volume fraction (ECV). In this pilot study, we hypothesize that CMR-determined LV diastolic dysfunction in diabetic patients is associated with increased ECV measured by T1 mapping. 17 DM patients (6 males, age 63±10 years old) without macrovascular diseases were examined on a 1.5T MR system. LV systolic and diastolic function was determined using a short-axis SSFP stack, T1 map and average LV myocardium T1 at pre- and post-contrast was derived from a T1 prep or a modified Look-Locker sequence performed in a mid-LV level. Post-contrast late gadolinium enhancement (LGE) CMR was performed 15 minutes post injection of Gd-DTPA. LV systolic function and LGE determination used commercial software CMR42. LV diastolic functional parameters including peak filling rate (PFR) and time to peak filling rate (TPFR) were calculated using MASS software and were blinded to T1 analysis. T1 calculation used CMR42 or a customized Matlab code. Myocardial ECV = (1-haematocrit) × (ΔR1myocardium/ΔR1blood). Increased ECV was defined as ECV > 30%. The average LV functional parameters in 17 subjects were in the normal range (LVEF=61±6%, LVESV=45±17 ml, LVEDV=113±33 ml, LVSV=68±19 ml, LVM=103±25 g). No focal LGE was observed in this patient cohort. 8 of 17 subjects had ECV> 30% (ECV=38±9%) and the other 7 subjects had ECV<30% (23±5%). There is no statistically significant difference (P>0.05) in LV systolic functional parameters of LVEF, LVESV, LVEDV, LVSV and LVM between the increased ECV and normal ECV group. However, a statistically significant difference (P<0.05) was observed among diastolic functional parameters of TPFR and PFR, with significantly longer TPFR (344±148 vs.156±32 ms) and lower PFR (220±50 vs. 295±74 ml/s) observed in the increased ECV group. Also a statistically significant difference (P<0.05) was observed in pre-contrast T1 measurements. Increased ECV was observed in diabetic patients with preserved systolic function and this was associated with altered LV diastolic function. The increased ECV may indicate the presence of diffuse interstitial fibrosis and myocardial stiffness, thus limiting the LV diastolic relaxation.

44-Year-Old Man With Exertional Dyspnea, Weight Loss, and Palpitations

44-Year-Old Man With Exertional Dyspnea, Weight Loss, and Palpitations

Quantifying late gadolinium enhancement on CMR provides additional prognostic information in early risk-stratification of nonischemic cardiomyopathy: a cohort study.

BackgroundSuspected nonischemic cardiomyopathy (NICM) is a common clinical setting with highly variable prognosis. Early noninvasive risk-stratification is important for justification of invasive examinations, specific treatment and patient surveillance. We studied the additional prognostic value of late gadolinium enhancement (LGE) and segmental wall motion abnormality (SWMA) extent on cardiovascular magnetic resonance (CMR) compared to traditional risk factors in suspected NICM.MethodsIn this observational cohort study, we enrolled 86 consecutive patients referred for CMR due to suspected NICM. Patients with ischemic cardiomyopathy were excluded. CMR images were analysed for left ventricular LGE and SWMA extents and patients were followed-up for major adverse cardiac events (MACE), including cardiovascular death, aborted sudden death and cardiac transplantation.ResultsOf 86 patients (median age: 53 years, 45% female), mainly presenting with ventricular arrhythmias (40%) and congestive heart failure (44%), 76% were finally diagnosed with NICM, 17% with left ventricle hypertrophy and 7% with idiopathic arrhythmia. On CMR, 61 patients (71%) had LGE and 56 (65%) SWMA. During median follow-up of 835 days, 15 patients (17%) reached MACE. In univariant analysis, LGE volume (hazard ratio [HR] 1.028 per 1% increase in LGE, p < 0.001), left ventricular ejection fraction (LVEF) (HR 0.959, p = 0.009) and SWMA score (HR 1.067, p = 0.012) had strongest associations with MACE. In multivariate analysis, the best overall model for event prediction included LGE volume (HR 1.027, p = 0.003), sustained ventricular tachycardia (HR 4.7, p = 0.011) and LVEF (HR 0.962, p = 0.034). Among patients with LGE, there was an event rate of 26% (14 of 61) versus 4% (1 of 25) in patients without LGE (p = 0.041, Log-rank). The highest event rate was observed in patients with LGE volume of ≥17%. Patients without SWMA did not experience MACE (p = 0.002, Log-rank), giving additional information in the subgroup of patients with preserved LVEF (≥50%).ConclusionsIn suspected NICM, presenting with ventricular arrhythmias or heart failure, LGE extent gives additional prognostic information compared to traditional risk factors, while the absence of SWMA may give prognostic information beyond normal LVEF. Even though the final diagnosis is uncertain in NICM, extensive amount of LGE should be considered as a sign of poor prognosis.

The relationship between electrocardiographic changes and CMR features in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy.

To investigate the relationship between electrocardiographic (ECG) abnormalities and left ventricular (LV) segmental hypertrophy and myocardial fibrosis assessed by cardiovascular magnetic resonance (CMR) in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy (HCM). 118 asymptomatic or mildly symptomatic patients with HCM were examined with late gadolinium enhancement (LGE) CMR, 12-lead ECG, and echocardiography. The distribution and magnitude of LV segmental hypertrophy and LGE were assessed and analyzed in relation to ECG abnormalities. Abnormal electrocardiograms were found in 113 of 118 (95%) patients. Negative T waves were associated with greater apical septal thickness (P = 0.009) and an increased ratio of LV septum to free wall thickness (P = 0.01). Giant negative T waves (GNT) were found in 19 patients (16%), and were associated with apical HCM (P < 0.001), greater apical thickness (P = 0.004), and increased ratio of LV apical to basal wall thickness (P < 0.001). However, no significant association was demonstrated between GNT and apical LGE (P = 0.71). Abnormal Q waves were associated with greater basal anteroseptal thickness (P = 0.001), maximal basal thickness (P = 0.004), and more segments with extensive LGE (>75% wall thickness involved) (P = 0.001). LV hypertrophy was related to greater LV mass (P = 0.002) and LV end diastolic volume (P = 0.002). In addition, a modest but significant correlation was observed between maximum LV wall thickness and the Romhilt-Estes score (r = 0.41, P < 0.001). GNT were associated with apical HCM and an increased ratio of LV apical to basal wall thickness. Abnormal Q waves were related to basal anteroseptal hypertrophy and segmental extensive LGE.

Co-occurring Duchenne muscular dystrophy and hypertrophic cardiomyopathy in an adult with atypical cardiac phenotype

We present the case of a 29-year-old man with mutation-positive Duchenne muscular dystrophy and mutation-positive hypertrophic cardiomyopathy. His cardiac phenotype has characteristics of both disorders; he manifests sub-epicardial left ventricular free wall late gadolinium enhancement that is consistent with Duchenne cardiomyopathy, as well as asymmetric ventricular septal hypertrophy, hyperdynamic left ventricular systolic function, and septal mid-myocardial late gadolinium enhancement, which are characteristic of hypertrophic cardiomyopathy.

Incidental MRI findings of left ventricular myocardial scar in atrial fibrillation patients is associated with increased stroke risk

Background Left ventricular late gadolinium enhancement (LV-LGE) is a known incidental cardiac magnetic resonance (CMR) finding in atrial fibrillation (AF) patients and has recently been associated with increased mortality [1]. While LV-LGE is an indicator of poor prognosis in patients with cardiomyopathy, data on the clinical significance of incidental findings of LV-LGE in AF patients is still unavailable. We aimed to evaluate the association of this incidental finding to ischemic stroke in atrial fibrillation.

Dynamic changes in myocardial architecture after reperfused acute myocardial infarction (AMI): insights from the prospective REMI study (REmodeling after Myocardial Infarction)

Background Following an acute infarction, a dynamic healing process initiates via extracellular substrate deposition and turnover, resulting in ongoing remodeling of infarct territory and global function change of left ventricle. Our prospective study was designed to investigate by CMR the dynamic changes in myocardial architecture at 2-4 days and 6 months following a reperfused AMI. Methods 66 consecutive patients who fulfilled inclusion criteria underwent two CMRs: 2-4 days (baseline) and 6 months (follow-up) after the AMI, comprising SSFP images for analysis of left ventricular functions and late gadolinium enhancement (LGE) MRI (0.1 mmol/Kg; DOTAREM ® , GUERBET, Roissy, France) for infarct analysis using a threshold method. Of 132 CMRs, 6 (4 from baseline) were non-diagnostic owing to poor EKG triggering and/or inability of the patients to hold their breath; 5 patients without evidence of infarct scar by LGE were also excluded. Hence, 57 patients (50 male; 56.7 ± 13.2 yo) were eventually analyzed. Total infarct was determined as area with signal intensity (SI) above mean+5SD of remote myocardium and was further divided into peri-infarct zone (PIZ) and infarct core by introducing a 7SD threshold; microvascular obstruction was manually included into the core; a core to PIZ ratio(C/PIZ) was calculated and a transmurality score was computed using a 5-point scale on the 16-segment model derived from the AHA model. Paired t-test was used for comparison between the two MRI and Pearson’s correlation coefficients were calculated to assess prediction of LV parameters. Results 14 patients (25%) had an AMI in the LAD territory; 18 patients (31.6%) presented microvascular obstruction on LGE images at baseline. Dynamic changes of infarct indices and LV functional parameters are detailed in table 1; LVEF improved significantly (p < 0.0001), owing to a decrease of LVESV (p < 0.05), possibly related to stunning at subacute phase; the increase of LVEDV remained mild, possibly indicative that most of LV remodeling occurred prior to the baseline MRI. Total infarct, core and PIZ mass all diminished significantly (p < 0.0001 for all). Both C/PIZ and transmurality score remained identical. Both total scar and infarct core masses at baseline were predictive of LVEF, LVEDV and LVESV at follow-up (table 2), but not of the change in LV functional parameters. Conclusions Following reperfused AMI, our study demonstrated a significant improvement in LVEF, related to an improved contractility due to stunning in the subacute phase. Myocardial damage characteristics by LGE showed a decrease of infarct size, owing to resorption of myocardial edema, in the same amount between its two components, core and PIZ. Funding

First-pass Stress Perfusion MR Imaging Findings of Apical Hypertrophic Cardiomyopathy: with Relation to LV Wall Thickness and Late Gadolinium-enhancement

목적: 심첨형 비후성 심근병증 환자에서 스트레스 부하 관류 자기공명영상을 통한 관류 결손의 빈도와 양상을 평가하고, 이를 좌심실 비대의 정도와 지연 조영 증강과 비교해 보고자 한다. 대상과 방법: 2008년 1월부터 2012년 12월까지 심초음파 및 심전도로 심첨형 비후성 심근병증을 진단받고, 스트레스 부하 관류, 영화 영상 및 지연 조영 증강 영상을 포함하는 심장 자기공명영상을 시행한 26명의 환자를 대상으로 하였다. 영화 영상에서 이완기 말에 416개 분절의 좌심실 벽 두께를 분석하였고 비후된 분절의 수와 연속하여 비후된 벽 분절의 수를 조사하였다. 또한 모든 환자에서 관류 결손과 지연 조영 증강의 유무를 평가하였다. 자기공명영상에서 관류 결손이 있을 경우, 산발형 혹은 고리형의 2가지 형태로 분류하였다. 단변량 분석을 통해 전체 관류 결손과 고리형 관류 결손에 대한 독립 변수를 산출하였다. 결과: 심첨형 비후성 심근병증의 76.9%(20명)에서 스트레스 부하 관류 자기공명영상시 관류 결손을 보였으며 이중 60% (12명)이 고리형 관류 결손을 보였다. 전체 관류 결손에 대한 독립 변수는 최대 좌심실 벽 두께와 비후된 분절의 수 였고 (p 【Purpose : To evaluate the prevalence and pattern of perfusion defect (PD) on first-pass stress perfusion MR imaging in relation with the degree of left ventricular hypertrophy (LVH) and late gadolinium-enhancement (LGE) in patients with apical hypertrophic cardiomyopathy (APH). Materials and Methods: Cardiac MR imaging with first-pass stress perfusion, cine, and LGE sequence was performed in 26 patients with APH from January 2008 to December 2012. We analyzed a total of 416 segments for LV wall thickness on end-diastolic phase of cine images, and evaluated the number of hypertrophied segment and number of consecutive hypertrophied segment (NCH). We assessed the presence or absence of PD and LGE from all patients. If there was PD, we subdivided the pattern into sporadic (sporadic-PD) or ring (ring-PD). Using univariate logistic method, we obtained the independent predictor for presence of overall PD and ring-PD. Results: PD on stress perfusion MRI was observed in 20 patients (76.9%), 12 of them (60%) showed ring-PD. Maximal LV wall thickness and number of hypertrophied segment were independent predictors for overall PD (all, p】

Cardiac Tissue Characterization and the Diagnostic Value of Cardiovascular Magnetic Resonance in Systemic Connective Tissue Diseases

Accurate diagnosis of cardiovascular involvement in connective tissue diseases (CTDs) remains challenging. We hypothesized that cardiovascular magnetic resonance (CMR) demonstrates cardiac lesions in symptomatic CTD patients with normal echocardiography. CMR from 246 CTD patients with typical cardiac symptoms (TCS; n = 146, group A) or atypical cardiac symptoms (ATCS; n = 100, group B) was retrospectively evaluated. Group A included 9 patients with inflammatory myopathy (IM), 35 with sarcoidosis, 30 with systemic sclerosis (SSc), 14 with systemic lupus erythematosus (SLE), 10 with rheumatoid arthritis (RA), and 48 with small vessel vasculitis. Group B included 25 patients with RA, 20 with SLE, 20 with sarcoidosis, 15 with SSc, 10 with IM, and 10 with small vessel vasculitis. CMR was performed by 1.5T; left ventricular ejection fraction, T2 ratio (edema imaging), and late gadolinium enhancement (LGE; fibrosis imaging) were evaluated. Acute and chronic lesions were characterized as LGE positive plus T2 ratio >2 and T2 ratio ≤2, respectively. According to LGE, lesions were characterized as diffuse subendocardial, subepicardial, and subendocardial/transmural due to vasculitis, myocarditis, and myocardial infarction, respectively. A stress study by dobutamine echocardiography or stress, nuclear, or adenosine CMR was performed in CTD patients with negative rest CMR. Abnormal CMR was identified in 32% (27% chronic) and 15% (12% chronic) of patients with TCS and ATCS, respectively. Lesions due to vasculitis, myocarditis, and myocardial infarction were evident in 27.4%, 62.6%, and 9.6% of CTD patients, respectively. Stress studies in CTD patients with negative CMR revealed coronary artery disease in 20%. CMR in symptomatic CTD patients with normal echocardiography can assess disease acuity and identify vasculitis, myocarditis, and myocardial infarction.

T-wave inversions related to left ventricular basal hypertrophy and myocardial fibrosis in non-apical hypertrophic cardiomyopathy: A cardiovascular magnetic resonance imaging study

ObjectivesTo investigate the relationship between T-wave inversions and left ventricular (LV) segmental hypertrophy and myocardial fibrosis assessed by cardiovascular magnetic resonance (CMR) in patients with non-apical hypertrophic cardiomyopathy (HCM). Methods196 consecutive patients with non-apical HCM underwent late gadolinium enhancement (LGE) CMR and 12-lead electrocardiogram. The distribution and magnitude of LV segmental hypertrophy and LGE were assessed according to the AHA 17-segment model and analyzed in relation to T-wave inversions. ResultsOf 196 HCM patients, 144 (73%) exhibited T-wave inversions. 144 (73%) patients had evidence of myocardial fibrosis as defined by LGE, and the prevalence of LGE was significantly higher in patients with T-wave inversions compared with those without T-wave inversions (78% vs. 59%, P=0.008). T-wave inversions were related to basal anterior and basal anteroseptal LGE (20% vs. 10%, P=0.04 and 68% vs. 46%, P=0.005, respectively). In addition, T-wave inversions were associated with greater basal anteroseptal and basal inferior wall thickness (19.5±4.7mm vs. 16.7±4.5mm, P<0.001 and 10.9±3.3mm vs. 9.6±3.0mm, P=0.01, respectively). By logistic regression analysis, basal anteroseptal wall thickness and LGE were independent determinants of T-wave inversions (P=0.005, P=0.01, respectively). ConclusionsT-wave inversions in HCM are associated with LGE and wall thickness of the left ventricular basal segments. Moreover, basal anteroseptal wall thickness and LGE are independent determinants of T-wave inversions.

Cardiac MRI: T2-Mapping Versus T2-Weighted Dark-Blood TSE Imaging for Myocardial Edema Visualization in Acute Myocardial Infarction

To assess the diagnostic accuracy of T2 mapping for the detection of myocardial edema in acute myocardial infarction (AMI), and to compare this diagnostic accuracy with that of the current standard for myocardial edema imaging, which is T2w dark-blood TSE imaging. 29 patients with AMI were examined at 1.5 T. For the visualization of myocardial edema, T2 maps, calculated from three T2w SSFP images, and T2w dark-blood TSE images were acquired in standard short- and long-axis views. Cine SSFP images were acquired for the analysis of left ventricular (LV) function and late gadolinium enhancement images (LGE) for the visualization of myocardial necrosis. The T2 maps as well as the T2w dark-blood TSE images were evaluated twice independently from the cine SSFP and LGE images. The presence or absence of myocardial edema was rated visually for each LV segment. As the standard of reference, the infarct zone was defined based on the cine SSFP and the LGE images. In this segment-based analysis, T2 mapping showed a sensitivity of 82 % and a specificity of 94 % for the detection of edema in the infarct zone. T2w dark-blood TSE imaging revealed a sensitivity of 50 % and a specificity of 98 %. T2 mapping showed a higher intra-rater agreement compared to T2w dark-blood TSE imaging (κ: 0.87 vs. 0.76). T2 mapping allows for the visualization of myocardial edema in AMI with a high sensitivity and specificity, and features better diagnostic accuracy in terms of a higher sensitivity compared to T2w dark-blood TSE imaging. Citation Format: • Naßenstein K, Nensa F, Schlosser T et al. Cardiac MRI: T2-Mapping Versus T2-Weighted Dark-Blood TSE Imaging for Myocardial Edema Visualization in Acute Myocardial Infarction. Fortschr Röntgenstr 2014; 186: 166 - 172.

The Incidence, Pattern, and Prognostic Value of Left Ventricular Myocardial Scar by Late Gadolinium Enhancement in Patients With Atrial Fibrillation

This study sought to identify the frequency, pattern, and prognostic significance of left ventricular (LV) late gadolinium enhancement (LGE) in patients with atrial fibrillation (AF). There are limited data on the presence, pattern, and prognostic significance of LV myocardial fibrosis in patients with AF. LGE during cardiac magnetic resonance imaging is a marker for myocardial fibrosis. A group of 664 consecutive patients without known prior myocardial infarction who were referred for radiofrequency ablation of AF were studied. Cardiac magnetic resonance imaging was requested to assess pulmonary venous anatomy. Overall, 73% were men, with a mean age of 56 years and a mean LV ejection fraction of 56 ± 10%. LV LGE was found in 88 patients (13%). The endpoint was all-cause mortality, and in this cohort, 68 deaths were observed over a median follow-up period of 42 months. On univariate analysis, age (hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 1.03 to 1.08; chi-square likelihood ratio [LRχ(2)]: 15.2; p = 0.0001), diabetes (HR: 2.39; 95% CI: 1.41 to 4.09; LRχ(2): 10.3; p = 0.001), a history of heart failure (HR: 1.78; 95% CI: 1.09 to 2.91; LRχ(2): 5.37; p = 0.02), left atrial dimension (HR: 1.04; 95% CI: 1.01 to 1.08; LRχ(2): 6.47; p = 0.01), presence of LGE (HR: 5.08; 95% CI: 3.08 to 8.36; LRχ(2): 28.8; p < 0.0001), and LGE extent (HR: 1.15; 95% CI: 1.10 to 1.21; LRχ(2): 35.6; p < 0.0001) provided the strongest associations with mortality. The mortality rate was 8.1% per patient-year in patients with LGE compared with 2.3% patients without LGE. In the best overall multivariate model for mortality, age and the extent of LGE were independent predictors of mortality. Indeed, each 1% increase in the extent of LGE was associated with a 15% increased risk for death. In patients with AF, LV LGE is a frequent finding and is a powerful predictor of mortality.

GW24-e0343 CMR findings in patients with hypertrophic cardiomyopathy and negative T waves

ObjectivesWe sought to compare the clinical, morphologic and functional characteristics by late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM) with and without negative T waves.Methods275...

Sinus rhythm restores ventricular function in patients with cardiomyopathy and no late gadolinium enhancement on cardiac magnetic resonance imaging who undergo catheter ablation for atrial fibrillation

Atrial fibrillation (AF) and systolic heart failure (HF) frequently coexist. Restoration of sinus rhythm by catheter ablation may result in a variable improvement in left ventricular (LV) function. Late-gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging identifies irreversible structural change and may predict incomplete recovery of LV function. To prospectively select patients with AF and symptomatic HF but without LV LGE and report the impact of AF ablation on LV function. Patients with AF and symptomatic HF (LV ejection fraction <50%) resistant to at least 1 antiarrhythmic drug and prior electrical cardioversion underwent contrast-enhanced CMR. LGE-negative patients underwent pulmonary vein isolation and left atrial roof line with continued antiarrhythmic medications until follow-up CMR 6 months postablation. Sixteen patients (aged 52 ± 11 years; mean AF duration 37 ± 39 months; left atrial size 44 ± 13 mL/m(2)) underwent AF ablation. At 6 months, 15 of the 16 patients maintained sinus rhythm and underwent CMR. LV ejection fraction increased from 40% ± 10% at baseline to 60% ± 6% (P < .001) and LV end-systolic volume index decreased from 52 ± 12 to 36 ± 9 mL/m(2) (P < .001). Left atrial size decreased from 44 ± 13 to 36 ± 11 mL/m(2) (P < .01). In patients with AF and LV dysfunction in the absence of LGE on CMR, ventricular function normalizes following the restoration of sinus rhythm. CMR may assist in the selection of patients with combined AF and systolic HF most likely to benefit from catheter ablation.

Nocturnal Blood Pressure Pattern Affects Left Ventricular Remodeling and Late Gadolinium Enhancement in Patients with Hypertension and Left Ventricular Hypertrophy

BackgroundLeft ventricular hypertrophy (LVH) is an independent predictor of cardiac mortality, regardless of its etiology. Previous studies have shown that high nocturnal blood pressure (BP) affects LV geometry in hypertensive patients. It has been suggested that continuous pressure overload affects the development of LVH, but it is unknown whether persistent pressure influences myocardial fibrosis or whether the etiology of LVH is associated with myocardial fibrosis. Comprehensive cardiac magnetic resonance (CMR) including the late gadolinium enhancement (LGE) technique can evaluate both the severity of changes in LV geometry and myocardial fibrosis. We tested the hypothesis that the nocturnal non-dipper BP pattern causes LV remodeling and fibrosis in patients with hypertension and LVH.MethodsForty-seven hypertensive patients with LVH evaluated by echocardiography (29 men, age 73.0±10.4 years) were examined by comprehensive CMR and 24-h ambulatory blood pressure monitoring (ABPM).Results and ConclusionsAmong the 47 patients, twenty-four had nocturnal non-dipper BP patterns. Patients with nocturnal non-dipper BP patterns had larger LV masses and scar volumes independent of etiologies than those in patients with dipper BP patterns (p = 0.035 and p = 0.015, respectively). There was no significant difference in mean 24-h systolic BP between patients with and without nocturnal dipper BP patterns (p = 0.367). Among hypertensive patients with LVH, the nocturnal non-dipper blood pressure pattern is associated with both LV remodeling and myocardial fibrosis independent of LVH etiology.

Assessment of diastolic function from velocity-encoded cardiac magnetic resonance data in patients with hypertrophic cardiomyopathy

Background Diastolic dysfunction evaluation may be relevant for early diagnosis of hypertrophic cardiomyopathy (HCM) and subsequent risk assessment. The aim of our study was to assess phase contrast cardiac magnetic resonance (PCCMR) diastolic parameters obtained with a semi-automated method in relation to left ventricular (LV) remodeling and late gadolinium enhancement (LGE) in patients with HCM. Methods We studied 48 patients with HCM and 23 healthy volunteers matched for age, sex and body surface area (BSA). Mitral inflow and myocardial velocities were assessed using through plane 2D PC-CMR (VENC=150cm/s and 20cm/s respectively). Transmitral peak flow-rates (Ef and Af) and early E’ peak myocardial longitudinal velocity were obtained semi-automatically using CardFlow (INSERM U678). LV volumes, segmental thickness and mass were obtained from SSFP images. LGE volume was quantified semi-automatically using a 6 SD threshold. Results Peak myocardial longitudinal velocity E’ was significantly lower and E/E’ was significantly higher in patients with HCM compared with controls (Table). We found a linear relationship between decreased E’ and increased LV mass index (p<0.0001), decreased mass/end-diastolic volume (M/EDV) ratio (p<0.0001), increased LGE mass (p=0.04) and LGE extension (p=0.04). The relationships between E’ and LV mass index and M/EDV were independent of age, gender, BSA and systolic blood pressure (p<0.001). Conclusions Comparison of patients with HCM and healthy volunteers by CMR showed significantly altered LV diastolic function related to LV hypertrophy and LGE. Assessment of diastolic function may be considered for a comprehensive cardiac evaluation in HCM. Funding None.

Left ventricular function, aortic velocity, and late gadolinium enhancement assessed by real-time and single shot CMR is comparable to breath-held segmented imaging: a prospective study

Methods Thirteen patients referred to the CMR lab for evaluation of undiagnosed cardiomyopathy were prospectively enrolled. All patients were in regular cardiac rhythm and able to breath-hold. Standard segmented k-space images (including cine, velocity mapping (VM), and late-gadolinium enhancement (LGE)) were acquired during breathhold; real-time images (including cine, VM, and LGE) were acquired during free-breathing. Relevant imaging parameters are listed in Table 1. Breath-held and real-time studies for LGE were blinded and scored on a segmental basis for presence or absence of enhancement by two reviewers. LVEF was calculated using Simpson’s rule on short-axis BH cines, and biplane area-length methodology on long-axis RT cines. EF results were averaged across cardiac cycles when RT cine spanned more than one heartbeat. Peak velocity through the aortic valve was assessed in BH and RT images and compared. Maximum peak velocity was used when RT images spanned more than one heartbeat.

Multi-contrast late enhancement CMR determined gray zone and papillary muscle involvement predict appropriate ICD therapy in patients with ischemic heart disease.

BackgroundMyocardial infarct heterogeneity indices including peri-infarct gray zone are predictors for spontaneous ventricular arrhythmias events after ICD implantation in patients with ischemic heart disease. In this study we hypothesize that the extent of peri-infarct gray zone and papillary muscle infarct scores determined by a new multi-contrast late enhancement (MCLE) method may predict appropriate ICD therapy in patients with ischemic heart disease.MethodsThe cardiovascular magnetic resonance (CMR) protocol included LV functional parameter assessment and late gadolinium enhancement (LGE) CMR using the conventional method and MCLE post-contrast. The proportion of peri-infarct gray zone, core infarct, total infarct relative to LV myocardium mass, papillary muscle infarct scores, and LV functional parameters were statistically compared between groups with and without appropriate ICD therapy during follow-up.ResultsTwenty-five patients with prior myocardial infarct for planned ICD implantation (age 64±10 yrs, 88% men, average LVEF 26.2±10.4%) were enrolled. All patients completed the CMR protocol and 6–46 months follow-up at the ICD clinic. Twelve patients had at least one appropriate ICD therapy for ventricular arrhythmias at follow-up. Only the proportion of gray zone measured with MCLE and papillary muscle infarct scores demonstrated a statistically significant difference (P < 0.05) between patients with and without appropriate ICD therapy for ventricular arrhythmias; other CMR derived parameters such as LVEF, core infarct and total infarct did not show a statistically significant difference between these two groups.ConclusionsPeri-infarct gray zone measurement using MCLE, compared to using conventional LGE-CMR, might be more sensitive in predicting appropriate ICD therapy for ventricular arrhythmia events. Papillary muscle infarct scores might have a specific role for predicting appropriate ICD therapy although the exact mechanism needs further investigation.