Distribution of late gadolinium enhancement in various types of cardiomyopathies: Significance in differential diagnosis, clinical features and prognosis

Abstract

The recent development of cardiac magnetic resonance (CMR) techniques has allowed detailed analyses of cardiac function and tissue characterization with high spatial resolution. We review characteristic CMR features in ischemic and non-ischemic cardiomyopathies (ICM and NICM), especially in terms of the location and distribution of late gadolinium enhancement (LGE). CMR in ICM shows segmental wall motion abnormalities or wall thinning in a particular coronary arterial territory, and the subendocardial or transmural LGE. LGE in NICM generally does not correspond to any particular coronary artery distribution and is located mostly in the mid-wall to subepicardial layer. The analysis of LGE distribution is valuable to differentiate NICM with diffusely impaired systolic function, including dilated cardiomyopathy, end-stage hypertrophic cardiomyopathy (HCM), cardiac sarcoidosis, and myocarditis, and those with diffuse left ventricular (LV) hypertrophy including HCM, cardiac amyloidosis and Anderson-Fabry disease. A transient low signal intensity LGE in regions of severe LV dysfunction is a particular feature of stress cardiomyopathy. In arrhythmogenic right ventricular cardiomyopathy/dysplasia, an enhancement of right ventricular (RV) wall with functional and morphological changes of RV becomes apparent. Finally, the analyses of LGE distribution have potentials to predict cardiac outcomes and response to treatments.

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“…8,34,35 Another limitation was that quantification of scar by cardiac magnetic resonance was not preformed. 36,37 Increases in RV mass play a role in RV remodeling in PH, but were not performed. 23 Also, invasive or echocardiographic measures of diastolic function were not part of our study.…”

Management of cardiovascular conditions in a cohort of patients with HIV: experience from a joint HIV/cardiology clinic

“…During the initial years we also diagnosed DCM based on echocardiography; however in more recent years this practice has changed to using CMR in view of the diagnostic accuracy and the ability to differentiate between various cardiomyopathies. 22,23 CMR would also help in accurate assessment of LV ejection fraction (LVEF) in those with cardiomyopathy, thus guiding the clinician in management decisions. Accurate assessment of LVEF would also have implications on complex device therapy.…”

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“…Although clinical manifestations are similar, DCM is not a single stage of a disease spectrum but may include several undetermined aetiologies, such as chronic myocarditis, tachycardia-induced cardiomyopathy, drug-induced cardiomyopathy, alcoholic cardiomyopathy, undiagnosed cardiac sarcoidosis and end-stage hypertrophic cardiomyopathy 1. Despite therapeutic advances in heart failure, the mortality and morbidity of DCM remain high.…”

“…Table 1 shows the different CMR sequences applied for the diagnosis and evaluation of DCM. CMR is now capable of identifying cardiac abnormalities not readily recognised by conventional imaging modalities 1. Among several techniques of MRI sequences, late gadolinium enhancement (LGE)-CMR relies on the delivery of intravenous gadolinium chelate to the myocardium, and it is sensitive and reproducible in the detection of myocardial scarring (ie, replacement fibrosis).…”

“…Many research groups have been studying LGE in various cardiomyopathies and attempting to verify the values for differential diagnosis, clinical features and prognosis. In DCM, LGE is not only a marker of differentiation from secondary cardiomyopathies, but it may also provide intriguing information regarding patient prognosis 1. In fact, the presence of mid-wall LGE was predictive of inducible ventricular tachycardia and of the lack of LV reverse remodelling after cardiac resynchronisation therapy (CRT), allowing the selection of ideal candidates for an implantable cardioverter-defibrillator or CRT-defibrillator 2 3.…”