Myocardial delayed contrast enhancement in patients with arterial hypertension: Initial results of cardiac MRI

Andersen, Kjel; Hennersdorf, M.; Cohnen, Mathias; Blondin, D.; Mödder, Ulrich; Poll, L. W.

doi:10.1016/j.ejrad.2008.03.009

Cited by 31 publications

(19 citation statements)

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“…These findings were sometimes accompanied by diffuse LV oedema and mild foci of midventricular or subepicardial enhancement on LGE images. [20][21][22] Hypertrophic CM was diagnosed in cases showing a focal or diffuse wall thickness of $18 mm and an increased normalized myocardial mass, along with the presence of areas of fibrosis within the thickened myocardium. 20,21,23 Cardiac amyloidosis was diagnosed in cases exhibiting concentric hypertrophy of the right and left myocardium and thickening of valve leaflets, atrial walls and septum, as well as LGE imaging results showing global or subendocardial enhancement of these structures.…”

Section: Cardiac Mri Analysismentioning

confidence: 99%

Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries

Emrich

Emrich²,

Abegunewardene³

et al. 2015

BJR

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Section: Cardiac Mri Analysismentioning

confidence: 99%

Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries

Emrich

Emrich²,

Abegunewardene³

et al. 2015

BJR

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“…1 Furthermore, pathological findings have confirmed that myocardial interstitial fibrosis was common in systemic hypertension. However, the mechanism of LGE was still unclear in these patients.…”

mentioning

confidence: 49%

Histopathological Basis of Myocardial Late Gadolinium Enhancement in Patients With Systemic Hypertension

Yan

2014

Circulation

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A 59-year-old man was admitted with exertional dyspnea. He had a 10-year history of uncontrolled systemic hypertension and the maximum level of blood pressure was 200/140 mm Hg. Chest x-ray showed cardiomegaly with pulmonary venous congestion, and the cardiothoracic ratio was 74%. Coronary arterial disease was excluded with selective coronary angiography, and hypertensive heart disease was diagnosed. Contrast-enhanced MRI demonstrated that the left ventricle dilated with systolic dysfunction, and the hypertrophy of the left ventricular wall was identified ( Figure 1A and 1B). The left ventricular end-diastolic dimension was 94 mm, and the left ventricular ejection fraction was 21%. The thickness of the interventricular septum was 16 mm, the lateral wall was 8 mm, and the anterior wall was 8.4 mm. Furthermore, diffuse late gadolinium enhancement (LGE) occurred in the left ventricular wall, mainly in the midwall of the interventricular septum and the subendocardium of the free wall ( Figure 2A). In the inferior and inferolateral segments of the left ventricle, near-transmural LGE presented ( Figure 2B and 2C).One week later, the informed consent was obtained and heart transplantation was performed. The pathological findings of the explanted heart were compared with the previous in vivo MRI. In the midwall of interventricular septum with LGE, myocardial interstitial fibrosis was identified ( Figure 3A and 3B). The collagen volume fraction was 16% in the histological section, which came from the region of midwall LGE in the interventricular septum. In the myocardium of the interventricular septum without LGE, there was no significant increase in the content of fibrosis. In the subendocardium of inferior and inferolateral segments, myocardial replacement fibrosis was detected ( Figure 4A and 4B). In the mid and outer myocardium of the corresponding wall, however, diffuse myocardial interstitial fibrosis was identified ( Figure 4C and 4D), especially in the subepicardium. The epicardial coronary arteries were normal in the patient.Previous researches have suggested that 45% of patients with systemic hypertension had myocardial LGE.1 Furthermore, pathological findings have confirmed that myocardial interstitial fibrosis was common in systemic hypertension. However, the mechanism of LGE was still unclear in these patients.LGE relied on relative differences in signal intensities. [2][3][4] Therefore, it was accepted that myocardial interstitial fibrosis was usually missed by LGE. In this study, we made a comparison between the myocardial LGE and histological findings in a patient with systemic hypertension who underwent heart transplantation. The results of this study demonstrated the histological basis of myocardial LGE in patients with systemic hypertension: localized myocardial interstitial fibrosis in the midwall (or outer myocardium) and replacement fibrosis in the subendocardium. Sources of FundingThe research was supported by National Natural Science Foundation of China (81341045) and Peking Union Medical College ...

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“…The study of Rudolph et al (22) adds prolonged AH with LVH to the range of conditions associated with cardiac LGE and is broadly in accord with a contemporaneous publication by Andersen et al (23). Just as preliminary work suggests LGE in HCM might be a predictor of sudden death (14) or ventricular arrhythmias (24), perhaps LGE in the AH with LVH population will prove to be the imaging link to increased cardiovascular risk in this population.…”

Section: See Page 284mentioning

confidence: 60%

Left Ventricular Hypertrophy and Excess Cardiovascular Mortality

Chuang

Manning

2009

Journal of the American College of Cardiology

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Left ventricular hypertrophy (LVH) is well established as a predictor of excess cardiovascular morbidity and mortality. Initial studies demonstrated an association between electrocardiographic LVH and likelihood of adverse events, but at acceptable levels of specificity, the sensitivity of the electrocardiogram for LVH is low. Subsequently, M-mode echocardiographically determined LVH was shown to predict cardiovascular morbidity and mortality independent of clinical risk factors including age, sex, smoking, and diabetes (1). The additional risk associated with LVH has been attributed to factors such as subendocardial ischemia related to perfusion gradient or increased arrhythmogenicity due in part to changes in myocardial substrate, but noninvasive in vivo methods for characterizing myocardial composition are neither widely available nor commonly used in the clinical setting. See page 284Although not currently approved by the Food and Drug Administration (FDA) for imaging of the heart, gadolinium chelates are widely used in cardiovascular magnetic resonance (CMR) as T1-shortening contrast agents. Work in the mid-1980s, with a canine coronary-ligation model, demonstrated that irreversibly injured myocardium exhibits significantly shortened T1 as compared with normal myocardium when imaged 5 min after intravenous injection of high-dose (0.5 mmol/kg) gadolinium (2,3). These and similar early studies were limited by the relatively low image contrast (typically Ͻ50%) between normal and irreversibly injured myocardium achieved with spin-echo CMR imaging. Subsequent work with inversion-recovery segmented gradient echo CMR methods were able to achieve signal intensity differences of up to 500% between normal and infarcted myocardium (4,5), where normal myocardium is dark and infarcted myocardium is enhanced (bright). The fundamental technique is straightforward: intravenous injection of gadolinium contrast followed by inversion recovery imaging after a 10-to 15-min delay. This is known in the CMR world as late gadolinium enhancement (LGE), delayed enhancement, delayed hyperenhancement, or delayed contrast enhancement.With inversion-recovery segmented gradient echo methods, comparison with necropsy in animals demonstrated that LGE is able to identify and accurately localize even very small infarcts (4). Both animal and human studies showed that LGE is able to identify both acute and chronic permanent myocardial injury and differentiates between irreversibly injured and stunned or hibernating myocardium. Further, LGE imaging has excellent agreement with positron emission tomography for determination of extent of myocardial scar (6) and is superior to single photon emission-computed tomography for identifying small infarcts, due to the enhanced spatial resolution of CMR methods (7). Landmark studies by Kim et al. (8) and others (9,10) showed that extent and transmurality of LGE was predictive of recovery of function after mechanical revascularization. Whereas initial data suggested that LGE was specific for irreversible is...

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Myocardial delayed contrast enhancement in patients with arterial hypertension: Initial results of cardiac MRI

Cited by 31 publications

References 18 publications

Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries

Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries

Histopathological Basis of Myocardial Late Gadolinium Enhancement in Patients With Systemic Hypertension

Left Ventricular Hypertrophy and Excess Cardiovascular Mortality

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