ReviewThe Prognostic Role of Late Gadolinium Enhancement Magnetic Resonance Imaging in Patients With Cardiomyopathy
Section snippets
What Is LGE CMRI?
LGE imaging takes advantage of the paramagnetic properties and differential washout kinetics of gadolinium-based contrast agents in normal vs abnormal myocardium. Based on its molecular structure, gadolinium is restricted to the extracellular compartment, reliably excluded from the intracellular space by intact cell membranes.2 Following its first pass through tissue, it is preferentially distributed to the interstitium unless cell membranes are disrupted. Accordingly, contrast enhancement
LGE CMR in ICM
Ischemia related to coronary artery disease results in reversible states of myocardial stunning and hibernation but, with sustained blood flow reductions, progresses to irreversible myocyte necrosis. Following evolution of the inflammatory cascade, the latter will conclude with removal of cellular debris and local generation of collagen-rich replacement fibrosis. The transmural extent and spatial distribution of this fibrous tissue can be exquisitely imaged by LGE imaging (Fig. 1A) and provides
LGE CMRI in DCM
Patients with DCM experience a 10-year mortality rate in excess of 40%,40 a risk shown to be reduced through the use of ICDs.41 Accordingly, interest in markers of future arrhythmic events in this population has expanded. The first substantive report of LGE findings in DCM was performed by McCrohon et al. in 2003. This study examined 90 patients with systolic heart failure, 63 having DCM defined by the findings of invasive catheterization, and reported that 28% of patients showed linear midwall
LGE CMRI in HCM
HCM is a leading cause of SCD among younger individuals and athletes.45 While the annual risk of SCD is now estimated to be below 1%, the relatively high prevalence of HCM (1 in 500 of the population) establishes this as an important contributor to cardiovascular mortality, particularly in the young.45 An expanding body of evidence supports a role for LGE CMRI for the identification of patients at elevated risk of arrhythmia-related events in HCM. Patients with HCM frequently show patchy,
LGE CMRI in Cardiac Sarcoidosis
Sarcoidosis is a chronic inflammatory disease characterized by the formation of granulomatous nodules, most typically affecting the lungs and lymph nodes, but any organ may be involved. Cardiac involvement is clinically evident in approximately 5% to 7% of patients and is acknowledged by the occurrence of heart block, ventricular tachyarrhythmias, or progressive systolic dysfunction. However, approximately one-third of patients will demonstrate subclinical cardiac involvement at autopsy.57 LGE
LGE CMRI in Cardiac Amyloidosis
Up to 50% of patients with systemic light-chain amyloid will develop cardiac involvement, a complication associated with elevated morbidity and premature mortality. In fact, 50% of patients will have died 6 months following diagnosis of cardiac involvement.61 While this condition was conventionally investigated by invasive myocardial biopsy, noninvasive diagnostic strategies are now becoming more routine. Leading these approaches is LGE CMRI, a preferred modality for confirmation or exclusion
Conclusions
With expanding clinical adoption of LGE CMRI for the identification and staging of disease in patients with cardiomyopathy, extraction of prognostic value from this imaging biomarker is particularly attractive. Given its novel identification of a pervasive pathophysiological end point, myocardial fibrosis, LGE imaging is well poised to become a versatile marker of future cardiovascular outcomes across a wide variety of cardiomyopathies. However, while this conclusion is strongly supported by
Funding Sources
Dr White is the principle investigator of Imaging to Guide Evaluation of Heart Failure (IMAGE HF)-project IC (Canadian Institutes for Health Research [CIHR] team grant (CIF#99470), which has helped to support this work.
Disclosures
Dr White receives in-kind research support from Bayer Inc Canada and has received consultative fees from Medtronic Inc. There are no other conflicts of interest or financial relationships to disclose.
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Long term cardiovascular magnetic resonance phenotyping of anthracycline cardiomyopathy
2019, International Journal of CardiologyCitation Excerpt :The early stages of anthracycline cardiomyopathy are characterized histologically by myocardial edema, inflammation and vacuolisation [11], whereas in the later stages, diffuse myocardial fibrosis predominates [12]. Discrete foci of myocardial fibrosis can be detected by late gadolinium enhancement (LGE) sequences with broad diagnostic and prognostic applications in cardiovascular medicine [13]. There are limited, somewhat conflicting data on the presence, extent and location of focal myocardial fibrosis detected by LGE in adult patients with anthracycline cardiomyopathy, [5,6,10,14] though it is generally reported to be an infrequent finding [11].
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2015, Journal of CardiologyCitation Excerpt :HCM is an idiopathic disease with pathological myocardial fibrosis, which is considered to be associated with ventricular arrhythmias and dysfunction [2,5,21]. To detect myocardial fibrosis, LGE was clinically validated and widely studied in HCM [22]. However, LGE is not able to be applied in patients with contrast agent contraindications.
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