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Banga S, Cardoso R, Castellani C, Srivastava S, Watkins J, Lima J. Cardiac MRI as an Imaging Tool in Titin Variant-Related Dilated Cardiomyopathy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:86-93. [PMID: 36934006 DOI: 10.1016/j.carrev.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/05/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
Dilated Cardiomyopathy is a common myocardial disease characterized by dilation and loss of function of one or both ventricles. A variety of etiologies have been implicated including genetic variation. Advancement in genetic sequencing, and diagnostic imaging allows for detection of genetic mutations in sarcomere protein titin (TTN) and high resolution assessment of cardiac function. This review article discusses the role of cardiac MRI in diagnosing dilated cardiomyopathy in patients with TTN variant related cardiomyopathy.
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Affiliation(s)
- Sandeep Banga
- Division of Cardiology, Michigan State University, Sparrow Hospital, Lansing, MI, USA.
| | | | - Carson Castellani
- Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shaurya Srivastava
- Division of Internal Medicine, Michigan State University, Lansing, MI, USA
| | - Jennifer Watkins
- Division of Cardiology, Michigan State University, Sparrow Hospital, Lansing, MI, USA
| | - Joao Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
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Markousis-Mavrogenis G, Giannakopoulou A, Belegrinos A, Pons MR, Bonou M, Vartela V, Papavasiliou A, Christidi A, Kourtidou S, Kolovou G, Bacopoulou F, Chrousos GP, Mavrogeni SI. Cardiovascular Magnetic Resonance Imaging Patterns in Rare Cardiovascular Diseases. J Clin Med 2022; 11:6403. [PMID: 36362632 PMCID: PMC9657782 DOI: 10.3390/jcm11216403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 08/27/2023] Open
Abstract
Rare cardiovascular diseases (RCDs) have low incidence but major clinical impact. RCDs' classification includes Class I-systemic circulation, Class II-pulmonary circulation, Class III-cardiomyopathies, Class IV-congenital cardiovascular diseases (CVD), Class V-cardiac tumors and CVD in malignancy, Class VI-cardiac arrhythmogenic disorders, Class VII-CVD in pregnancy, Class VIII-unclassified rare CVD. Cardiovascular Magnetic Resonance (CMR) is useful in the diagnosis/management of RCDs, as it performs angiography, function, perfusion, and tissue characterization in the same examination. Edema expressed as a high signal in STIRT2 or increased T2 mapping is common in acute/active inflammatory states. Diffuse subendocardial fibrosis, expressed as diffuse late gadolinium enhancement (LGE), is characteristic of microvascular disease as in systemic sclerosis, small vessel vasculitis, cardiac amyloidosis, and metabolic disorders. Replacement fibrosis, expressed as LGE, in the inferolateral wall of the left ventricle (LV) is typical of neuromuscular disorders. Patchy LGE with concurrent edema is typical of myocarditis, irrespective of the cause. Cardiac hypertrophy is characteristic in hypertrophic cardiomyopathy (HCM), cardiac amyloidosis (CA) and Anderson-Fabry Disease (AFD), but LGE is located in the IVS, subendocardium and lateral wall in HCM, CA and AFD, respectively. Native T1 mapping is increased in HCM and CA and reduced in AFD. Magnetic resonance angiography provides information on aortopathies, such as Marfan, Turner syndrome and Takayasu vasculitis. LGE in the right ventricle is the typical finding of ARVC, but it may involve LV, leading to the diagnosis of arrhythmogenic cardiomyopathy. Tissue changes in RCDs may be detected only through parametric imaging indices.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Flora Bacopoulou
- University Research Institute for Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, “Agia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George P. Chrousos
- University Research Institute for Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, “Agia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sophie I. Mavrogeni
- Onassis Cardiac Surgery Center, 17674 Athens, Greece
- University Research Institute for Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, “Agia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Demir AR, Celik O, Ustündağ S, Uygur B, Somuncu MU, Yilmaz E, Avci Y, Demirci G, Kahraman S, Erturk M. Relationship between Late Gadolinium Enhancement and Ventricular Repolarization Parameters in Heart Failure Patients with Reduced Ejection Fraction. Arq Bras Cardiol 2021; 117:678-687. [PMID: 34231793 PMCID: PMC8528364 DOI: 10.36660/abc.20200149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/15/2020] [Accepted: 09/09/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heart failure with reduced ejection fraction (HFrEF) is a highly prevalent disease that requires repeating hospitalizations, causes significant morbidity and mortality. Therefore, early recognition of poor outcome predictors is essential for patient management. OBJECTIVE The aim of the present study is to investigate the relationship between late gadolinium enhancement (LGE) detected by cardiac magnetic resonance (CMR) and repolarization parameters such as corrected QT (QTc) interval, Tp-e interval, frontal QRS-T angle detected by 12 lead electrocardiograph (ECG) in HFrEF. METHOD In this single-center, retrospective observational study included 97 consecutive HFrEF patients who had CMR scan. Study population was divided into two groups according to the presence of LGE. Echocardiographic and CMR measurements and demographic features were recorded. QTc intervals, Tp-e intervals, frontal QRS-T angles were calculated from the ECG. A p-value less than 0.05 was considered statistically significant. RESULTS LGE was detected in 52 (53.6%) out of 97 HFrEF patients. QTc intervals (p=0.001), Tp-e intervals (p<0.001), frontal QRS-T angles (p<0.001) were found to be significantly higher in LGE group when compared to non-LGE group. In univariate regression analysis which was performed to investigate the predictors of LGE in HFrEF, all three repolarization parameters were reached significant values but in multivariate analysis the only repolarization parameter remained significant was Tp-e interval (OR=1.085 95% CI 1.032-1.140, p=0.001). CONCLUSION With the prolongation of the Tp-e interval, the presence of myocardial fibrosis which is an arrhythmogenic substrate, can be predicted in patients with HFrEF.
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Affiliation(s)
- Ali Riza Demir
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
| | - Omer Celik
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
| | - Songül Ustündağ
- Departamento de CardiologiaErzincan Binali Yıldırım University Mengücek Gazi TrainingResearch HospitalErzincanTurquia Departamento de Cardiologia , Erzincan Binali Yıldırım University Mengücek Gazi Training and Research Hospital , Erzincan - Turquia
| | - Begum Uygur
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
| | - Mustafa Umut Somuncu
- Departamento de CardiologiaZonguldak Bülent Ecevit UniversityFaculty of MedicineZonguldakTurquia Departamento de Cardiologia , Zonguldak Bülent Ecevit University Faculty of Medicine , Zonguldak - Turquia
| | - Emre Yilmaz
- Departamento de CardiologiaGörele Op. Dr. Ergun Ozdemir State HospitalGiresunTurquia Departamento de Cardiologia , Görele Op. Dr. Ergun Ozdemir State Hospital , Giresun - Turquia
| | - Yalcin Avci
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
| | - Gokhan Demirci
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
| | - Serkan Kahraman
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
| | - Mehmet Erturk
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
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Csecs I, Pashakhanloo F, Paskavitz A, Jang J, Al-Otaibi T, Neisius U, Manning WJ, Nezafat R. Association Between Left Ventricular Mechanical Deformation and Myocardial Fibrosis in Nonischemic Cardiomyopathy. J Am Heart Assoc 2020; 9:e016797. [PMID: 33006296 PMCID: PMC7792406 DOI: 10.1161/jaha.120.016797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background In patients with nonischemic cardiomyopathy, nonischemic fibrosis detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance is related to adverse cardiovascular outcomes. However, its relationship with left ventricular (LV) mechanical deformation parameters remains unclear. We sought to investigate the association between LV mechanics and the presence, location, and extent of fibrosis in patients with nonischemic cardiomyopathy. Methods and Results We retrospectively identified 239 patients with nonischemic cardiomyopathy (67% male; 55±14 years) referred for a clinical cardiovascular magnetic resonance. LGE was present in 109 patients (46%), most commonly (n=52; 22%) in the septum. LV deformation parameters did not differentiate between LGE‐positive and LGE‐negative groups. Global longitudinal, radial, and circumferential strains, twist and torsion showed no association with extent of fibrosis. Patients with septal fibrosis had a more depressed LV ejection fraction (30±12% versus 35±14%; P=0.032) and more impaired global circumferential strain (−7.9±3.5% versus −9.7±4.4%; P=0.045) and global radial strain (10.7±5.2% versus 13.3±7.7%; P=0.023) than patients without septal LGE. Global longitudinal strain was similar in both groups. While patients with septal‐only LGE (n=28) and free wall–only LGE (n=32) had similar fibrosis burden, the septal‐only LGE group had more impaired LV ejection fraction and global circumferential, longitudinal, and radial strains (all P<0.05). Conclusions There is no association between LV mechanical deformation parameters and presence or extent of fibrosis in patients with nonischemic cardiomyopathy. Septal LGE was associated with poor global LV function, more impaired global circumferential and radial strains, and more impaired global strain rates.
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Affiliation(s)
- Ibolya Csecs
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Farhad Pashakhanloo
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Amanda Paskavitz
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Jihye Jang
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Talal Al-Otaibi
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Ulf Neisius
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Warren J Manning
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Reza Nezafat
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
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Yuan X, Mao S, Tang Q. Analysis of the incidence and baseline predictors of the left ventricular ejection fraction returning to normal after dilated cardiomyopathy in postmenopausal women: a retrospective, observational study. J Int Med Res 2020; 48:300060520922471. [PMID: 32429729 PMCID: PMC7241211 DOI: 10.1177/0300060520922471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To analyse the incidence and baseline predictors of the left ventricular ejection fraction (LVEF) returning to normal after dilated cardiomyopathy (DCM) following intervention with standard anti-heart failure (HF) medication in postmenopausal women. Methods Data from consecutive postmenopausal women who were first diagnosed with DCM and received anti-HF treatment during 2011 to 2018 were prospectively retrieved. The study population was divided into the LVEF recovery (LVR) group and the LVEF unrecovered (LVU) group according to whether LVEF was > 50%. The primary endpoint was baseline predictors of LVEF returning to normal. Results LVEF returned to normal in 49.3% (210/426) of patients with DCM. LVEF was significantly higher in the LVR group than in the LVU group (57.4% ± 6.9% vs 44.2% ± 5.3%; hazard ratio 1.312, 95% confidence interval 1.015–1.726) at the final follow-up. High systolic pressure, a short history of HF, a short QRS interval, a small left ventricular end-diastolic diameter (LVEDd), and high LVEF at admission were independent predictors of LVEF returning to normal. Conclusions LVEF returning to normal in postmenopausal women with DCM who receive standard anti-HF treatment is associated with systolic pressure, a history of HF, QRS interval, LVEDd, LVEF at admission, and favourable outcome.
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Affiliation(s)
- Xiaopin Yuan
- Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute of Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Shuai Mao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qizhu Tang
- Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute of Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
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Kim H, Kim IC, Choi SW, Chung JW, Kim JY. Clinical significance of early-diastolic tissue velocity imaging of lateral mitral annulus for prognosis of nonischemic left ventricular dysfunction. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:160-167. [PMID: 31675137 DOI: 10.1002/jcu.22787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/08/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE We explored the potential of tissue velocity imaging (TVI) for prognosis of nonischemic left ventricular (LV) dysfunction (LVD). METHODS We reviewed 138 nonischemic LVD patients (58 ± 14 years) who underwent both cardiac magnetic resonance (CMR) and echocardiography. Septal and lateral mitral annular TVI data were compared with late gadolinium enhancement (LGE) on CMR. During a mean follow-up of 24 months, recovery (>15%) of LV ejection fraction and clinical outcomes (cardiovascular death and heart failure hospitalization) were assessed. RESULTS LGE was commonly observed in the basal anteroseptal, inferoseptal, and inferior segments, but infrequently observed in the anterolateral segment. LGE was associated with lower early diastolic, septal (Sep-e' = 5.2 ± 2.0 vs 6.9 ± 2.0 cm/s, P = .031) and lateral (Lat-e' = 7.3 ± 3.0 vs 9.5 ± 2.0 cm/s, P < .001) TVI. The relationship between Lat-e' and anterolateral LGE (area under the curve, AUC 0.834) was much better than that between Sep-e' and inferoseptal LGE (AUC 0.699). The 60 patients with LVD reversibility revealed higher Lat-e' (9.8 ± 2.0 vs 6.7 ± 2.2 cm/s, P < .001) and lower LGE burden (7.3 ± 9.0 vs 22 ± 10%, P < .001), while Lat-e' ≤ 7.8 cm/s appeared unfavorable for 31 events patients. On multivariate analyses, Lat-e' (HR 0.79, 95% CI 0.63-0.99, P = .044) and LVD reversibility (HR 0.53, 95% CI 0.16-0.90, P = .018) were still meaningful together with LGE segments and burden. CONCLUSION Lat-e' was related with LVD reversibility and a significant predictor of clinical outcomes.
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Affiliation(s)
- Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sang-Woong Choi
- Division of Cardiology, Department of Internal Medicine, Daegu Dongsan Hospital, Daegu, Republic of Korea
| | - Jin-Wook Chung
- Division of Cardiology, Department of Internal Medicine, Daegu Dongsan Hospital, Daegu, Republic of Korea
| | - Jin Young Kim
- Department of Radiology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
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Ko SM, Kim TH, Chun EJ, Kim JY, Hwang SH. Assessment of Left Ventricular Myocardial Diseases with Cardiac Computed Tomography. Korean J Radiol 2019; 20:333-351. [PMID: 30799565 PMCID: PMC6389818 DOI: 10.3348/kjr.2018.0280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/03/2018] [Indexed: 01/09/2023] Open
Abstract
Rapid advances in cardiac computed tomography (CT) have enabled the characterization of left ventricular (LV) myocardial diseases based on LV anatomical morphology, function, density, and enhancement pattern. Global LV function and regional wall motion can be evaluated using multi-phasic cine CT images. CT myocardial perfusion imaging facilitates the identification of hemodynamically significant coronary artery disease. CT delayed-enhancement imaging is used to detect myocardial scar in myocardial infarction and to measure the extracellular volume fraction in non-ischemic cardiomyopathy. Multi-energy cardiac CT allows the mapping of iodine distribution in the myocardium. This review summarizes the current techniques of cardiac CT for LV myocardial assessment, highlights the key findings in various myocardial diseases, and presents future applications to complement echocardiography and cardiovascular magnetic resonance.
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Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
| | - Tae Hoon Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Young Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
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Ko SM, Hwang SH, Lee HJ. Role of Cardiac Computed Tomography in the Diagnosis of Left Ventricular Myocardial Diseases. J Cardiovasc Imaging 2019; 27:73-92. [PMID: 30993942 PMCID: PMC6470070 DOI: 10.4250/jcvi.2019.27.e17] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/26/2018] [Accepted: 01/10/2019] [Indexed: 01/09/2023] Open
Abstract
Multimodality imaging is indicated for the evaluation of left ventricular (LV) myocardial diseases. Cardiac magnetic resonance (CMR) allows morphological and functional assessment of the LV along with soft tissue characterization. Technological advances in cardiac computed tomography (CT) have led to the development of techniques for diagnostic acquisition in LV myocardial disease. Cardiac CT facilitates the characterization of LV myocardial disease based on anatomy, function, and enhancement pattern. LV regional and global functional parameters are evaluated using multi-phasic cine CT images. CT myocardial perfusion facilitates the identification of hemodynamically significant coronary artery stenosis. Cardiac CT with delayed enhancement is used to detect myocardial scarring or fibrosis in myocardial infarction and non-ischemic cardiomyopathy, and for the measurement of extracellular volume fraction in non-ischemic cardiomyopathy. In this review, we review imaging techniques and key imaging features of cardiac CT used for the evaluation of myocardial diseases, along with CMR findings.
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Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Hye Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Liu T, Ma X, Liu W, Ling S, Zhao L, Xu L, Song D, Liu J, Sun Z, Fan Z, Luo T, Kang J, Liu X, Dong J. Late Gadolinium Enhancement Amount As an Independent Risk Factor for the Incidence of Adverse Cardiovascular Events in Patients with Stage C or D Heart Failure. Front Physiol 2016; 7:484. [PMID: 27840608 PMCID: PMC5083842 DOI: 10.3389/fphys.2016.00484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/10/2016] [Indexed: 01/06/2023] Open
Abstract
Background: Myocardial fibrosis (MF) is a risk factor for poor prognosis in dilated cardiomyopathy (DCM). Late gadolinium enhancement (LGE) of the myocardium on cardiac magnetic resonance (CMR) represents MF. We examined whether the LGE amount increases the incidence of adverse cardiovascular events in patients with stage C or D heart failure (HF). Methods: Eighty-four consecutive patients with stage C or D HF, either ischemic or non-ischemic, were enrolled. Comprehensive clinical and CMR evaluations were performed. All patients were followed up for a composite endpoint of cardiovascular death, heart transplantation, and cardiac resynchronization therapy with defibrillator (CRT-D). Results: LGE was present in 79.7% of the end-stage HF patients. LGE distribution patterns were mid-wall, epi-myocardial, endo-myocardial, and the morphological patterns were patchy, transmural, and diffuse. During the average follow-up of 544 days, 13 (15.5%) patients had endpoint events: 7 patients cardiac death, 2 patients heart transplantation, and 4 patients underwent CRT-D implantation. On univariate analysis, LGE quantification on cardiac magnetic resonance, blood urine nitrogen, QRS duration on electrocardiogram, left ventricular end-diastolic diameter (LVEDD), and left ventricular end-diastolic volume (LVEDV) on CMR had the strongest associations with the composite endpoint events. However, on multivariate analysis for both Model I (after adjusting for age, sex, and body mass index) and Model II (after adjusting for age, sex, BMI, renal function, QRS duration, and atrial fibrillation on electrocardiogram, the etiology of HF, LVEF, CMR-LVEDD, and CMR-LVEDV), LGE amount was a significant risk factor for composite endpoint events (Model I 6SD HR 1.037, 95%CI 1.005–1.071, p = 0.022; Model II 6SD HR 1.045, 95%CI 1.001–1.084, p = 0.022). Conclusion: LGE amount from high-scale threshold on CMR increased the incidence of adverse cardiovascular events for patients in either stage C or D HF.
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Affiliation(s)
- Tong Liu
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Xiaohai Ma
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Wei Liu
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Shukuan Ling
- State Key Lab of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center Beijing, China
| | - Lei Zhao
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Lei Xu
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Deli Song
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Jie Liu
- Department of Vascular Surgery, Chinese PLA General Hospital Beijing, China
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, School of Science, Curtin University Perth, WA, Australia
| | - Zhanming Fan
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Taiyang Luo
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Junping Kang
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Xiaohui Liu
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
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Kim SS, Ko SM, Choi SI, Choi BH, Stillman AE. Sudden cardiac death from structural heart diseases in adults: imaging findings with cardiovascular computed tomography and magnetic resonance. Int J Cardiovasc Imaging 2016; 32 Suppl 1:21-43. [PMID: 27139460 DOI: 10.1007/s10554-016-0891-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 02/07/2023]
Abstract
Sudden cardiac death (SCD) is defined as the unexpected natural death from a cardiac cause within an hour of the onset of symptoms in the absence of any other cause. Although such a rapid course of death is mainly attributed to a cardiac arrhythmia, identification of structural heart disease by cardiovascular computed tomography (CCT) and cardiovascular magnetic resonance (CMR) imaging is important to predict the long-term risk of SCD. In adults, SCD most commonly results from coronary artery diseases, coronary artery anomalies, inherited cardiomyopathies, valvular heart diseases, myocarditis, and aortic dissection with coronary artery involvement or acute aortic regurgitation. This review describes the CCT and CMR findings of structural heart diseases related to SCD, which are essential for radiologists to diagnose or predict.
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Affiliation(s)
- Song Soo Kim
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea.
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Bo Hwa Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Arthur E Stillman
- Department of Radiology, Division of Cardiothoracic Imaging, Emory University Hospital, Atlanta, GA, USA
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Zhou H, Lin X, Fang L, Zhao X, Ding H, Chen W, Xu R, Bai X, Wang Y, Fang Q. Characterization of Compacted Myocardial Abnormalities by Cardiac Magnetic Resonance With Native T1 Mapping in Left Ventricular Non-Compaction Patients – A Comparison With Late Gadolinium Enhancement –. Circ J 2016; 80:1210-6. [DOI: 10.1253/circj.cj-15-1269] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hongmei Zhou
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Xue Lin
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Ligang Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine
| | - Haiyan Ding
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine
| | - Wei Chen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Ruiyi Xu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Xiaoyin Bai
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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12
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Francone M. Role of cardiac magnetic resonance in the evaluation of dilated cardiomyopathy: diagnostic contribution and prognostic significance. ISRN RADIOLOGY 2014; 2014:365404. [PMID: 24967294 PMCID: PMC4045555 DOI: 10.1155/2014/365404] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/05/2013] [Indexed: 01/07/2023]
Abstract
Dilated cardiomyopathy (DCM) represents the final common morphofunctional pathway of various pathological conditions in which a combination of myocyte injury and necrosis associated with tissue fibrosis results in impaired mechanical function. Recognition of the underlying aetiology of disease and accurate disease monitoring may be crucial to individually optimize therapeutic strategies and stratify patient's prognosis. In this regard, CMR has emerged as a new reference gold standard providing important information for differential diagnosis and new insight about individual risk stratification. The present review article will focus on the role of CMR in the evaluation of present condition, analysing respective strengths and limitations in the light of current literature and technological developments.
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Affiliation(s)
- Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324 00161 Rome, Italy
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13
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Tanabe T, Rozycki HJ, Kanoh S, Rubin BK. Cardiac asthma: new insights into an old disease. Expert Rev Respir Med 2013; 6:705-14. [PMID: 23234454 DOI: 10.1586/ers.12.67] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac asthma has been defined as wheezing, coughing and orthopnea due to congestive heart failure. The clinical distinction between bronchial asthma and cardiac asthma can be straight forward, except in patients with chronic lung disease coexisting with left heart disease. Pulmonary edema and pulmonary vascular congestion have been thought to be the primary causes of cardiac asthma but most patients have a poor response to diuretics. There appears to be limited effectiveness of classical asthma medications like bronchodilators or corticosteroids in treating cardiac asthma. Evidence suggests that circulating inflammatory factors and tissue growth factors also lead to airway obstruction suggesting the possibility of developing novel therapies.
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Affiliation(s)
- Tsuyoshi Tanabe
- Department of Pediatrics, Virginia Commonwealth University School of Medicine and the Children's Hospital of Richmond at VCU, Richmond, VA, USA
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14
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Moreo A, Ambrosio G, De Chiara B, Tran T, Raman SV. Influence of midwall fibrosis on diastolic dysfunction in non-ischemic cardiomyopathy. Int J Cardiol 2012; 163:342-344. [PMID: 23041098 DOI: 10.1016/j.ijcard.2012.09.104] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 09/16/2012] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | - Tam Tran
- Ohio State University, Columbus, OH, United States
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15
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Holmström M, Kivistö S, Heliö T, Jurkko R, Kaartinen M, Antila M, Reissell E, Kuusisto J, Kärkkäinen S, Peuhkurinen K, Koikkalainen J, Lötjönen J, Lauerma K. Late gadolinium enhanced cardiovascular magnetic resonance of lamin A/C gene mutation related dilated cardiomyopathy. J Cardiovasc Magn Reson 2011; 13:30. [PMID: 21689390 PMCID: PMC3135551 DOI: 10.1186/1532-429x-13-30] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/20/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify early features of lamin A/C gene mutation related dilated cardiomyopathy (DCM) with cardiovascular magnetic resonance (CMR). We characterise myocardial and functional findings in carriers of lamin A/C mutation to facilitate the recognition of these patients using this method. We also investigated the connection between myocardial fibrosis and conduction abnormalities. METHODS Seventeen lamin A/C mutation carriers underwent CMR. Late gadolinium enhancement (LGE) and cine images were performed to evaluate myocardial fibrosis, regional wall motion, longitudinal myocardial function, global function and volumetry of both ventricles. The location, pattern and extent of enhancement in the left ventricle (LV) myocardium were visually estimated. RESULTS Patients had LV myocardial fibrosis in 88% of cases. Segmental wall motion abnormalities correlated strongly with the degree of enhancement. Myocardial enhancement was associated with conduction abnormalities. Sixty-nine percent of our asymptomatic or mildly symptomatic patients showed mild ventricular dilatation, systolic failure or both in global ventricular analysis. Decreased longitudinal systolic LV function was observed in 53% of patients. CONCLUSIONS Cardiac conduction abnormalities, mildly dilated LV and depressed systolic dysfunction are common in DCM caused by a lamin A/C gene mutation. However, other cardiac diseases may produce similar symptoms. CMR is an accurate tool to determine the typical cardiac involvement in lamin A/C cardiomyopathy and may help to initiate early treatment in this malignant familiar form of DCM.
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MESH Headings
- Adolescent
- Adult
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/genetics
- Cardiomyopathy, Dilated/physiopathology
- Chi-Square Distribution
- Contrast Media
- Electrocardiography
- Female
- Fibrosis
- Finland
- Genetic Predisposition to Disease
- Humans
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/genetics
- Lamin Type A/genetics
- Magnetic Resonance Imaging, Cine
- Male
- Meglumine
- Middle Aged
- Mutation
- Myocardium/pathology
- Organometallic Compounds
- Phenotype
- Predictive Value of Tests
- Severity of Illness Index
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/genetics
- Ventricular Function, Left
- Ventricular Function, Right
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Affiliation(s)
- Miia Holmström
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center) P.O. Box 340, FI-00029 HUS, Finland
| | - Sari Kivistö
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center) P.O. Box 340, FI-00029 HUS, Finland
| | - Tiina Heliö
- Department of Cardiology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUS, Finland
| | - Raija Jurkko
- Department of Cardiology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUS, Finland
| | - Maija Kaartinen
- Department of Cardiology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUS, Finland
| | - Margareta Antila
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center) P.O. Box 340, FI-00029 HUS, Finland
| | - Eeva Reissell
- Boehringer Ingelheim Finland Ky Tammasaarenkatu 5, FI-00180 Helsinki, Finland
| | - Johanna Kuusisto
- Heart Center, Kuopio University Hospital, P.O. Box 1777, FI-70211 Kuopio, Finland
| | - Satu Kärkkäinen
- Heart Center, Kuopio University Hospital, P.O. Box 1777, FI-70211 Kuopio, Finland
| | - Keijo Peuhkurinen
- Heart Center, Kuopio University Hospital, P.O. Box 1777, FI-70211 Kuopio, Finland
| | - Juha Koikkalainen
- VTT Technical Research Centre of Finland, P.O. Box 1300, FI-33101 Tampere, Finland
| | - Jyrki Lötjönen
- VTT Technical Research Centre of Finland, P.O. Box 1300, FI-33101 Tampere, Finland
| | - Kirsi Lauerma
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center) P.O. Box 340, FI-00029 HUS, Finland
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16
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Mewton N, Liu CY, Croisille P, Bluemke D, Lima JAC. Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J Am Coll Cardiol 2011; 57:891-903. [PMID: 21329834 PMCID: PMC3081658 DOI: 10.1016/j.jacc.2010.11.013] [Citation(s) in RCA: 690] [Impact Index Per Article: 53.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 11/08/2010] [Accepted: 11/19/2010] [Indexed: 02/08/2023]
Abstract
Diffuse interstitial or replacement myocardial fibrosis is a common feature of a broad variety of cardiomyopathies. Myocardial fibrosis leads to impaired cardiac diastolic and systolic function and is related to adverse cardiovascular events. Cardiovascular magnetic resonance (CMR) may uniquely characterize the extent of replacement fibrosis and may have prognostic value in various cardiomyopathies. Myocardial longitudinal relaxation time mapping is an emerging technique that could improve CMR's diagnostic accuracy, especially for interstitial diffuse myocardial fibrosis. As such, CMR could be integrated in the monitoring and therapeutic management of a large number of patients. This review summarizes the advantages and limitations of CMR for the assessment of myocardial fibrosis.
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Affiliation(s)
- Nathan Mewton
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland 21287-0409, USA
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17
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Takeda K, Matsumiya G, Hamada S, Sakaguchi T, Miyagawa S, Yamauchi T, Sawa Y. Left Ventricular Basal Myocardial Scarring Detected by Delayed Enhancement Magnetic Resonance Imaging Predicts Outcomes After Surgical Therapies for Patients With Ischemic Mitral Regurgitation and Left Ventricular Dysfunction. Circ J 2011; 75:148-56. [DOI: 10.1253/circj.cj-10-0304] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Koji Takeda
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
| | - Goro Matsumiya
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
| | - Seiki Hamada
- Department of Radiology, Osaka University Graduate School of Medicine
| | - Taichi Sakaguchi
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
| | - Shigeru Miyagawa
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
| | - Takashi Yamauchi
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
| | - Yoshiki Sawa
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
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18
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Takeuchi I, Imaki R, Inomata T, Soma K, Izumi T. MRI is useful for diagnosis of H1N1 fulminant myocarditis. Circ J 2010; 74:2758-9. [PMID: 20944436 DOI: 10.1253/circj.cj-10-0354] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ichiro Takeuchi
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
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19
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Cho JR, Park S, Choi BW, Kang SM, Ha JW, Chung N, Choe KO, Cho SY, Rim SJ. Delayed enhancement magnetic resonance imaging is a significant prognostic factor in patients with non-ischemic cardiomyopathy. Circ J 2010; 74:476-83. [PMID: 20118568 DOI: 10.1253/circj.cj-09-0446] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Delayed enhancement (DE) on cardiac magnetic resonance imaging (CMR) is a marker of myocardial fibrosis. The absence of DE in CMR is a predictor of left ventricular (LV) functional improvement in patients with non-ischemic cardiomyopathy (NICM), so in the present study it was investigated whether presence of DE has prognostic significance in patients with NICM at long-term follow-up. METHODS AND RESULTS The 79 patients (56.4+/-13.5 years, 48 males) with NICM (LV ejection fraction <35%, no significant coronary artery disease) were monitored for occurrence of cardiac events. CMR was performed to assess DE. Cardiac events were defined as rehospitalization (because of worsening of heart failure), cardiac transplantation or death. There were 37 patients without and 42 patients with DE. The mean follow-up duration was 19+/-10 months. There was 1 event (2.7%, 1 rehospitalization) in the DE (-) group, whereas 13 events (30.9%, 1 death, 1 transplantation, 11 rehospitalizations) occurred in the DE (+) group. The event-free survival was significantly longer in the DE (-) group than in the DE (+) group (38.9+/-1.0 vs 28.4+/-2.7 months, P<0.01). Multivariate regression analysis revealed that presence of DE was the most potent, independent predictor of cardiac events (hazard ratio 8.06, confidence interval 1.03+/-63.41, P<0.05). CONCLUSIONS The presence of DE in CMR is a significant predictor of future cardiac events in patients with NICM.
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Affiliation(s)
- Jung Rae Cho
- Cardiology Division, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Korea
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