BACKGROUND and OBJECTIVES-The study was designed to determine the prevalence of extracardiac findings discovered during multidetector computed tomography (MDCT) examinations prior to atrial fibrillation ablation. MDCT has become a valuable tool in detailing left atrial anatomy prior to catheter ablation. The incidence of extracardiac findings has been reported for electron beam CT calcium scoring (EBCT) and coronary MDCT, but no data exists for the prevalence of extracardiac findings discovered prior to atrial fibrillation ablation with MDCT.

OBJECTIVES The aim of this work was to characterize patterns of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance imaging in a hemodialysis population at high risk for cardiovascular events. BACKGROUND The prevalence and distribution of LGE and its relationship to left ventricular mass (LVM) and function in this population is unknown. METHODS Chronic hemodialysis patients at high risk for cardiovascular events—age >50 years, diabetes, or known cardiovascular disease—were enrolled prior to concerns regarding nephrogenic systemic fibrosis. Cardiovascular magnetic resonance imaging was performed in 24 patients (age, 59 ± 11 years; dialysis, 45 ± 38 months) and included steady-state free precession cine imaging and late gadolinium-enhanced, phase-sensitive, inversion-recovery gradient echo images. Left ventricular mass, volumes, and function were calculated and indexed to body surface area. A 16-segment analysis was performed to calculate percentage of LGE, LV wall thickness, and percentage of wall thickening. RESULTS Left ventricular ejection fraction was 48 ± 15%, and the LV mass index was 100 ± 52 g/m2. Late gadolinium enhancement was observed in 79% (19 of 24) of patients in 3 distinct patterns: infarct-related (32%, 6 of 19), diffuse (37%, 7 of 19), and focal noninfarct (37%, 7 of 19). Late gadolinium enhancement constituted 15 ± 18% of the LVM and correlated with LVM (r = 0.44, p = 0.03). A significant, inverse relationship existed between segmental LGE and the percentage of wall thickening (p > 0.0001). Excluding infarct-related segments, as end-diastolic wall thickness increased, so did LGE (p < 0.0001), and as LGE increased, the percentage of wall thickening decreased (p = 0.0012). After 23 ± 3 months of follow-up, 1 patient had developed nephrogenic systemic fibrosis. Seven of the patients (29%) had developed a hard cardiovascular event, 5 of 19 (26%) with LGE and 2 of 5 (40%) without. CONCLUSIONS Late gadolinium enhancement is prevalent in the hemodialysis population and its extent is related to LVM. Most cases of LGE are not infarct-related and are associated with hypertrophied, dysfunctional LV segments. Non-infarct-related LGE may signify fibrosis from LV hypertrophy and/or an infiltrative process. Further studies in this patient population will not be possible due to the risk of nephrogenic systemic fibrosis.

Cardiovascular magnetic resonance (CMR) of the superficial femoral artery (SFA) allows direct visualization of atherosclerotic plaque burden noninvasively. We examined atherosclerosis in 3 groups of patients without a history or symptoms of peripheral arterial disease (PAD) with varying expected burdens: those with diabetes mellitus (DM) and known coronary artery disease (CAD)(n=24); DM and a high prevalence of CAD risk factors (n=20); and controls of similar age without DM or CAD and few CAD risk factors (n=15). We also assessed the diagnostic accuracy of this technique to differentiate between these 3 groups. T1-weighted spin-echo images were used to measure the mean wall thickness (WT) and total wall volume indexed to total vessel volume (IWV). Diagnostic accuracy was assessed by area under the receiver operating characteristic (ROC) curve analysis. Individuals with DM+risk factors and DM+CAD had higher mean WT (1.28mm and 1.37mm) and mean IWV (0.53 and 0.56) compared with controls (mean WT 1.16mm and mean IWV 0.45), all p<0.010. Both mean WT and IWV showed good diagnostic accuracy in discriminating controls from those with DM+CAD (AUCs of 0.85 and 0.87 with p<0.001, respectively), while only IWV discriminated DM+risk factors from controls (AUC=0.82, p<0.001). Neither could discriminate between DM+risk factors and DM+CAD. In conclusion, patients with DM+risk factors and DM+CAD had significantly higher atherosclerotic burden in the SFA on CMR than controls of similar age, with good diagnostic accuracy in differentiating these groups. The high reproducibility and reliability of CMR of the SFA may facilitate improved assessment of atherosclerosis prevalence as well as progression/regression in studies of novel therapies.

Background-New left ventricular systolic dysfunction affects 500,000 Americans and coronary artery disease (CAD) is responsible for two-thirds of cases. Identifying CAD has both prognostic and therapeutic implications. We evaluated the ability of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance imaging (CMR) to detect CAD as the etiology of recent onset congestive heart failure (CHF).

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