Distribution of late gadolinium enhancement in end-stage hypertrophic cardiomyopathy and dilated cardiomyopathy: Differential diagnosis and prediction of cardiac outcome

• Published in: Magnetic resonance imaging 2014-02, Vol.32 (2), p.118-124
• Main Authors: Machii, Masashi, Satoh, Hiroshi, Shiraki, Katsunori, Saotome, Masao, Urushida, Tsuyoshi, Katoh, Hideki, Takehara, Yasuo, Sakahara, Harumi, Ohtani, Hayato, Wakabayashi, Yasushi, Ukigai, Hiroshi, Tawarahara, Kei, Hayashi, Hideharu
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cardiac magnetic resonance; Cardiomyopathy, Dilated - diagnosis; Cardiomyopathy, Dilated - pathology; Cardiomyopathy, Hypertrophic - diagnosis; Cardiomyopathy, Hypertrophic - pathology; Contrast Media - chemistry; Diagnosis, Differential; Dilated cardiomyopathy; Disease-Free Survival; Echocardiography, Doppler; End-stage hypertrophic cardiomyopathy; Female; Follow-Up Studies; Gadolinium DTPA - chemistry; Humans; Late gadolinium enhancement; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Myocardium - pathology; Outcomes; Radiology; Retrospective Studies; Reverse remodeling; Risk; Ultrasonography
• ISSN: 0730-725X; 1873-5894
• DOI: 10.1016/j.mri.2013.10.011

Abstract Background The prognostic implications of late gadolinium enhancement (LGE) have been evaluated in ischemic and non-ischemic cardiomyopathies. The present study analyzed LGE distribution in patients with end-stage hypertrophic cardiomyopathy (ES-HCM) and with dilated cardiomyopathy (DCM), and tried to identify high risk patients in DCM. Methods Eleven patients with ES-HCM and 72 with DCM underwent cine- and LGE-cardiac magnetic resonance and ultrasound cardiography. The patient outcome was analyzed retrospectively for 5 years of follow-up. Results LGE distributed mainly in the inter-ventricular septum, but spread more diffusely into other left ventricular segments in patients with ES-HCM and in a certain part of patients with DCM. Thus, patients with DCM can be divided into three groups according to LGE distribution; no LGE (n = 24), localized LGE (localized at septum, n = 36), and extensive LGE (spread into other segments, n = 12). Reverse remodeling occurred after treatment in patients with no LGE and with localized LGE, but did not in patients with extensive LGE and with ES-HCM. The event-free survival rate for composite outcome (cardiac death, hospitalization for decompensated heart failure or ventricular arrhythmias) was lowest in patients with extensive LGE (92%, 74% and 42% in no LGE, localized LGE, and extensive LGE, p = 0.02 vs. no LGE), and was comparable to that in patients with ES-HCM (42%). Conclusions In DCM, patients with extensive LGE showed no functional recovery and the lowest event-free survival rate that were comparable to patients with ES-HCM. The analysis of LGE distribution may be valuable to predict reverse remodeling and to identify high-risk patients.