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.

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: 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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References

  1. Poole JE. Present guidelines for device implantation: clinical considerations and clinical challenges from pacing, implantable cardiac defibrillator, and cardiac resynchronization therapy. Circulation. 2014; 129(3): 383–394.
  2. Birnie DH, Tang ASl. The problem of non-response to cardiac resynchronization therapy. Curr Opin Cardiol. 2006; 21(1): 20–26.
  3. Matusik PT. Cardiac resynchronization therapy: potential of left ventricular pacing. Eur Heart J. 2019; 40(21): 1667–1669.
  4. Kumar A, Bagur R. Cardiac magnetic resonance in clinical cardiology. World J Cardiol. 2015; 7(1): 6–9.
  5. Vogel-Claussen J, Rochitte CE, Wu KC, et al. Delayed enhancement MR imaging: utility in myocardial assessment. Radiographics. 2006; 26(3): 795–810.
  6. Tseng WYI, Su MYM, Tseng YHE. Introduction to cardiovascular magnetic resonance: technical principles and clinical applications. Acta Cardiol Sin. 2016; 32(2): 129–144.
  7. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction . Eur Heart J. 2019; 40(3): 237–269.
  8. Shanbhag SM, Greve AM, Aspelund T, et al. Prevalence and prognosis of ischaemic and non-ischaemic myocardial fibrosis in older adults. Eur Heart J. 2019; 40(6): 529–538.
  9. Gutman SJ, Costello BT, Papapostolou S, et al. Reduction in mortality from implantable cardioverter-defibrillators in non-ischaemic cardiomyopathy patients is dependent on the presence of left ventricular scar. Eur Heart J. 2019; 40(6): 542–550.
  10. Bleeker GB, Kaandorp TAM, Lamb HJ, et al. Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation. 2006; 113(7): 969–976.
  11. Cerqueira M, Weissman N, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. Circulation. 2002; 105(4): 539–542.
  12. Zakkaroff C, Biglands JD, Greenwood JP, et al. Patient-specific coronary blood supply territories for quantitative perfusion analysis. Comput Methods Biomech Biomed Eng Imaging Vis. 2018; 6(2): 137–154.
  13. Tyczyński P, Kukuła K, Pietrasik A, et al. Anomalous origin of culprit coronary arteries in acute coronary syndromes. Cardiol J. 2018; 25(6): 683–690.
  14. Spałek M, Stępień-Wałek A, Paszkiewicz J, et al. Double left anterior descending artery: Congenital anomaly or normal variant of coronary arteries? Cardiol J. 2017; 24(4): 445–446.
  15. Woźnica A, Tyczyński P, Brzozowski P, et al. Hypertrophic obstructive cardiomyopathy with anomalous left circumflex coronary artery. Kardiol Pol. 2018; 76(7): 1118.
  16. le Polain de Waroux JB, Pouleur AC, Goffinet C, et al. Combined coronary and late-enhanced multidetector-computed tomography for delineation of the etiology of left ventricular dysfunction: comparison with coronary angiography and contrast-enhanced cardiac magnetic resonance imaging. Eur Heart J. 2008; 29(20): 2544–2551.
  17. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37(27): 2129–2200.
  18. Mewton N, Liu CY, Croisille P, et al. Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J Am Coll Cardiol. 2011; 57(8): 891–903.
  19. Buckert D, Tibi R, Cieslik M, et al. Myocardial strain characteristics and outcomes after transcatheter aortic valve replacement. Cardiol J. 2018; 25(2): 203–212.
  20. Duncan AM, Francis DP, Gibson DG, et al. Differentiation of ischemic from nonischemic cardiomyopathy during dobutamine stress by left ventricular long-axis function: additional effect of left bundle-branch block. Circulation. 2003; 108(10): 1214–1220.
  21. McCrohon JA, Moon JCC, Prasad SK, et al. Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation. 2003; 108(1): 54–59.
  22. Valle-Muñoz A, Estornell-Erill J, Soriano-Navarro CJ, et al. Late gadolinium enhancement-cardiovascular magnetic resonance identifies coronary artery disease as the aetiology of left ventricular dysfunction in acute new-onset congestive heart failure. Eur J Echocardiogr. 2009; 10(8): 968–974.
  23. Soriano CJ, Ridocci F, Estornell J, et al. Noninvasive diagnosis of coronary artery disease in patients with heart failure and systolic dysfunction of uncertain etiology, using late gadolinium-enhanced cardiovascular magnetic resonance. J Am Coll Cardiol. 2005; 45(5): 743–748.
  24. Javadi MS, Lautamäki R, Merrill J, et al. Definition of vascular territories on myocardial perfusion images by integration with true coronary anatomy: a hybrid PET/CT analysis. J Nucl Med. 2010; 51(2): 198–203.
  25. Leong DP, Chakrabarty A, Shipp N, et al. Effects of myocardial fibrosis and ventricular dyssynchrony on response to therapy in new-presentation idiopathic dilated cardiomyopathy: insights from cardiovascular magnetic resonance and echocardiography. Eur Heart J. 2012; 33(5): 640–648.
  26. Gulati A, Jabbour A, Ismail TF, et al. Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy. JAMA. 2013; 309(9): 896–908.
  27. Wong TC, Piehler KM, Zareba KM, et al. Myocardial damage detected by late gadolinium enhancement cardiovascular magnetic resonance is associated with subsequent hospitalization for heart failure. J Am Heart Assoc. 2013; 2(6): e000416.
  28. Florian A, Ludwig A, Engelen M, et al. Left ventricular systolic function and the pattern of late-gadolinium-enhancement independently and additively predict adverse cardiac events in muscular dystrophy patients. J Cardiovasc Magn Reson. 2014; 16: 81.
  29. Matoh F, Satoh H, Shiraki K, et al. Usefulness of delayed enhancement magnetic resonance imaging to differentiate dilated phase of hypertrophic cardiomyopathy and dilated cardiomyopathy. J Card Fail. 2007; 13(5): 372–379.
  30. Bohl S, Wassmuth R, Abdel-Aty H, et al. Delayed enhancement cardiac magnetic resonance imaging reveals typical patterns of myocardial injury in patients with various forms of non-ischemic heart disease. Int J Cardiovasc Imaging. 2008; 24(6): 597–607.
  31. Satoh H, Sano M, Suwa K, et al. Distribution of late gadolinium enhancement in various types of cardiomyopathies: Significance in differential diagnosis, clinical features and prognosis. World J Cardiol. 2014; 6(7): 585–601.
  32. Choi DS, Ha JW, Choi B, et al. Extent of late gadolinium enhancement in cardiovascular magnetic resonance and its relation with left ventricular diastolic function in patients with hypertrophic cardiomyopathy. Circ J. 2008; 72(9): 1449–1453.
  33. Ypenburg C, Roes SD, Bleeker GB, et al. Effect of total scar burden on contrast-enhanced magnetic resonance imaging on response to cardiac resynchronization therapy. Am J Cardiol. 2007; 99(5): 657–660.
  34. Adam RD, Shambrook J, Flett AS. The prognostic role of tissue characterisation using cardiovascular magnetic resonance in heart failure. Card Fail Rev. 2017; 3(2): 86–96.
  35. Leyva F, Zegard A, Acquaye E, et al. Outcomes of cardiac resynchronization therapy with or without defibrillation in patients with nonischemic cardiomyopathy. J Am Coll Cardiol. 2017; 70(10): 1216–1227.
  36. Matusik PT. Adverse clinical outcomes related to right ventricular pacing. Eur Heart J. 2019; 40(20): 1586–1588.
  37. Matusik PT. Biomarkers and cardiovascular risk stratification. Eur Heart J. 2019; 40(19): 1483–1485.
  38. Matusik PS, Matusik PT, Stein PK. Heart rate variability in patients with systemic lupus erythematosus: a systematic review and methodological considerations. Lupus. 2018; 27(8): 1225–1239.
  39. Matusik PT, Prior SM, Butenas S, et al. Association of cardiac troponin I with prothrombotic alterations in atrial fibrillation. Kardiol Pol. 2018; 76(7): 1106–1109.
  40. Assomull RG, Prasad SK, Lyne J, et al. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol. 2006; 48(10): 1977–1985.
  41. Kwon DH, Obuchowski NA, Marwick TH, et al. Jeopardized myocardium defined by late gadolinium enhancement magnetic resonance imaging predicts survival in patients with ischemic cardiomyopathy: impact of revascularization. J Am Heart Assoc. 2018; 7(22): e009394.
  42. Di Bella G, Siciliano V, Aquaro GD, et al. Scar extent, left ventricular end-diastolic volume, and wall motion abnormalities identify high-risk patients with previous myocardial infarction: a multiparametric approach for prognostic stratification. Eur Heart J. 2013; 34(2): 104–111.
  43. Di Marco A, Anguera I, Schmitt M, et al. Late gadolinium enhancement and the Risk for ventricular arrhythmias or sudden death in dilated cardiomyopathy: systematic review and meta-analysis. JACC Heart Fail. 2017; 5(1): 28–38.
  44. Brown PF, Miller C, Di Marco A, et al. Towards cardiac MRI based risk stratification in idiopathic dilated cardiomyopathy. Heart. 2019; 105(4): 270–275.
  45. Agra Bermejo R, Gonzalez Babarro E, López Canoa JN, et al. Heart failure with recovered ejection fraction: Clinical characteristics, determinants and prognosis. CARDIOCHUS-CHOP registry. Cardiol J. 2018; 25(3): 353–362.
  46. Goldberger JJ, Buxton AE, Cain M, et al. Risk stratification for arrhythmic sudden cardiac death: identifying the roadblocks. Circulation. 2011; 123(21): 2423–2430.