Vol 28, No 1 (2021)
Original Article
Published online: 2020-02-05

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Ischemic and non-ischemic patterns of late gadolinium enhancement in heart failure with reduced ejection fraction

Patrycja S. Matusik1, Amira Bryll2, Paweł T. Matusik34, Tadeusz J. Popiela2
Pubmed: 32037500
Cardiol J 2021;28(1):67-76.


Background: Late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) may reveal
myocardial fibrosis which is associated with adverse clinical outcomes in patients undergoing implantable
cardioverter-defibrillator (ICD) placement. At the same time, transmural LGE in the posterolateral wall is
related to nonresponse to conventional cardiac resynchronization therapy (CRT). Herein, the aim was to
assess the presence and determinants of LGE in CMR in heart failure (HF) with reduced ejection fraction.

Methods: Sixty-seven patients were included (17.9% female, aged 45 [29–60] years), who underwent
LGE-CMR and had left ventricular ejection fraction (LVEF) as determined by echocardiography.

Results: In HF patients with LVEF ≤ 35% (n = 29), ischemic and non-ischemic patterns of LGE were
observed in 51.7% and 34.5% of patients, respectively. In controls (n = 38), these patterns were noted in
23.7% and 42.1% of patients, respectively. HF patients with LVEF ≤ 35% and transmural LGE in the
posterolateral wall (31.0%) were characterized by older age, coronary artery disease (CAD) and previous
myocardial infarction (MI) (61 ± 6 vs. 49 ± 16 years, p = 0.008, 100% vs. 40%, p = 0.003 and 78%
vs. 25%, p = 0.014, respectively). In patients with LVEF ≤ 35%, LGE of any type, diagnosed in 86.2%
of patients, was associated with CAD (68% vs. 0%, p = 0.02), while only trends were observed for its
association with older age and previous MI (p = 0.08 and p = 0.12, respectively).

Conclusions: Among HF patients with LVEF ≤ 35%, clinical factors including older age, CAD, and
previous MI are associated with transmural LGE in the posterolateral wall, while CAD is associated with LGE. This data may have potential implications for planning ICD and CRT placement procedures.

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