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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. Matusik, Amira Bryll, Paweł T. Matusik, Tadeusz J. Popiela
DOI: 10.5603/CJ.a2020.0009
·
Pubmed: 32037500

open access

Ahead of print
Original articles
Published online: 2020-02-05

Abstract

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: 67 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.

Abstract

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: 67 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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Keywords

heart failure, late gadolinium enhancement, ischemic, cardiac magnetic resonance, transmural late gadolinium enhancement, cardiac resynchronization therapy, implantable cardioverter-defibrillator

About this article
Title

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

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Research paper

Published online

2020-02-05

DOI

10.5603/CJ.a2020.0009

Pubmed

32037500

Keywords

heart failure
late gadolinium enhancement
ischemic
cardiac magnetic resonance
transmural late gadolinium enhancement
cardiac resynchronization therapy
implantable cardioverter-defibrillator

Authors

Patrycja S. Matusik
Amira Bryll
Paweł T. Matusik
Tadeusz J. Popiela

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