Late gadolinium enhancement in patients with Tetralogy of Fallot: A systematic review

Secchi, Francesco; Lastella, Giulia; Monti, Caterina Beatrice; Barbaro, Ugo; Capra, Davide; Zanardo, Moreno; Sardanelli, Francesco

doi:10.1016/j.ejrad.2021.109521

Cited by 7 publications

(7 citation statements)

References 39 publications

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“…In severe LV outflow obstructive pathologies, a diffuse fibrous lining of the endocardium known as endocardial fibroelastosis (EFE) can be seen as LGE in CMR, carrying a poor prognosis in many cases ( 15 ). LGE enhancement has also been associated with adverse outcomes in patients with repaired tetralogy of Fallot ( 16 , 17 ).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of gray-blood late gadolinium enhancement evaluation in young patients with congenital and acquired heart disease

Gonzalez de Alba,

Moghari,

Browne

et al. 2023

Front. Cardiovasc. Med.

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BackgroundLate gadolinium enhancement (LGE) sequences have become common in pediatric cardiovascular magnetic resonance (CMR) to assess for myocardial fibrosis. Bright-blood late gadolinium enhancement (BB-LGE) by conventional phase-sensitive inversion recovery (PSIR) is commonly utilized, but similar inversion time (TI) value of fibrosis and left ventricular (LV) blood pool can make subendocardial areas difficult to assess. A gray-blood LGE (GB-LGE) technique has been described, targeting nulling of the LV blood pool and demonstrating improvement in ischemic scar detection over BB-LGE in adult patients. We sought to evaluate the feasibility of the GB-LGE technique in a young population with congenital and acquired heart disease and compare its ability to detect subendocardial scar to conventional BB-LGE.MethodsSeventy-six consecutive patients referred for clinical CMR underwent both BB-LGE and GB-LGE on 1.5 T and 3 T scanners. Conventional PSIR sequences were obtained with TI to null the myocardium (BB-LGE) in short-axis and horizontal long-axis stacks. Same PSIR stacks were immediately repeated with TI to null the blood pool (GB-LGE). Both sequences were reviewed separately a week apart by two readers, blinded to the initial clinical interpretation. Studies were analyzed for overall image quality, confidence in scar detection, confidence in detection of LGE, LGE class, inter- and intra-observer agreement for the presence of scar, and intraclass correlation coefficient (ICC) for total scar burden.ResultsOverall confidence in myocardial scar detection by BB-LGE or GB-LGE as well as grading of image quality were not statistically different [(p = 1 and p = 1) and (p = 0.53, p = 0.18), respectively]. There was very good inter-observer agreement for the presence of scar on BB-LGE (K = 0.88, 95% CI 0.77–0.99) and GB-LGE (K = 0.84, 95% CI 0.7–0.96), as well as excellent intra-observer agreement for both readers (K = 0.93, 95% CI 0.87–0.99; and K = 0.81, 95% CI 0.69–0.95). Interclass correlation coefficient for total scar burden was excellent for BB-LGE (ICC = 0.98, 95% CI 0.96–0.99) and GB-LGE (ICC = 0.94, 95% CI 0.91–0.97).ConclusionsThe GB-LGE technique is feasible in the pediatric population with congenital and acquired heart disease. It can detect subendocardial/ischemic scar similar to conventional bright-blood PSIR sequences in the pediatric population.

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Section: Discussionmentioning

confidence: 99%

Feasibility of gray-blood late gadolinium enhancement evaluation in young patients with congenital and acquired heart disease

Gonzalez de Alba,

Moghari,

Browne

et al. 2023

Front. Cardiovasc. Med.

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“…The patterns of RV LGE in our cohort were similar to those previously reported, with the most common site for LGE being the RV outflow tract. [ 6 ] Several prior studies have identified the presence and extent of RV LGE as a risk factor for adverse long-term outcomes in TOF patients [ 2 , 12 , 13 , 22 ]. However, the serial rate of change in the RV LGE extent has not been previously studied.…”

Section: Discussionmentioning

confidence: 99%

“…Despite advances in the surgical, transcatheter, and medical management of Tetralogy of Fallot (TOF), late morbidity and mortality remain unacceptably high, related to chronic pulmonary regurgitation, ventricular dysfunction, and ventricular or atrial arrhythmias [1][2][3][4][5]. Right ventricular (RV) late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) study can occur due to surgical scarring or RV remodeling and has been associated with ventricular dysfunction, arrhythmia, and serum biomarkers of heart failure [6][7][8][9][10][11][12][13][14][15]. Although the prognostic significance of LGE in TOF has been previously documented, data regarding LGE progression over time are sparse [16].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal changes in extent of late gadolinium enhancement in repaired Tetralogy of Fallot: a retrospective analysis of serial CMRs

Saengsin

Lü

Sleeper

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Right ventricular (RV) late gadolinium enhancement (LGE) occurs due to surgical scarring and RV remodeling, and has been shown to be associated with clinical outcomes in Tetralogy of Fallot (TOF). However, it is not known if cardiovascular magnetic resonance (CMR) LGE extent progresses over time, and therefore, it is not known if serial reassessment of LGE is necessary. We determined the rate of progression in the extent of RV LGE on serial CMR examinations in repaired TOF. Methods Retrospective review of 127 patients after TOF repair (49% male, median age at first CMR 18.9 years (Interquartile range (IQR) 13.3,27.0) who had at least two CMRs (median follow-up duration of 4.0 years (IQR 2.1,5.9)) was performed. 84/127 patients had no interventions between serial CMRs (Group 1) while 43/127 patients had transcatheter or surgical intervention between CMRs (Group 2). The extent of RV LGE was assessed using 2 methods: a semiquantitative RV LGE score and a quantitative RV LGE extent expressed as % of RV mass. Mixed effects linear regression modeling to estimate changes in LGE over time. Results RV LGE was present in all patients on the first CMR. % RV LGE extent and LGE score did not increase over time in either patient group. The mean 5 year rates of change were small and negative for both % RV LGE extent [− 2.3 (95% CI − 2.9, − 1.8, p < 0.001) in Group 1, and − 1.9 (95% CI − 3.2, − 0.7, p = 0.004) in Group 2], and RV LGE score [− 0.9 (95% CI − 1.1, − 0.6, p < 0.001) in Group 1, and − 0.5 (95% CI − 1.1, − 0.0, p = 0.047) in Group 2]. Conclusions In this serial CMR evaluation of children and adults with repaired TOF, no significant progression in the extent of RV LGE was seen on intermediate term follow-up. Given recent concerns regarding the safety of gadolinium-based contrast agents, frequent assessment of LGE may not be necessary in follow-up.

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“…Se realiza una revisión sistemática que selecciona 18 artículos que analizan la prevalencia, las características y la relevancia clínica del realce tardío de gadolinio 13 en la tetralogía de Fallot. Se concluye que una mayor cantidad de realce tardío de gadolinio se relaciona con mayores volúmenes ventriculares, menor fracción de eyección y mayor insuficiencia pulmonar.…”

Section: Imagen En Cardiopatías Congénitasunclassified

Selección de lo mejor del año 2021 en cardiopatías congénitas

et al. 2022

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Late gadolinium enhancement in patients with Tetralogy of Fallot: A systematic review

Cited by 7 publications

References 39 publications

Feasibility of gray-blood late gadolinium enhancement evaluation in young patients with congenital and acquired heart disease

Feasibility of gray-blood late gadolinium enhancement evaluation in young patients with congenital and acquired heart disease

Longitudinal changes in extent of late gadolinium enhancement in repaired Tetralogy of Fallot: a retrospective analysis of serial CMRs

Selección de lo mejor del año 2021 en cardiopatías congénitas

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