Department of Radiology, University Hospital, Skawińska 8 Street, 33-332 Kraków, Poland.
Department of Diagnostic Imaging, Jagiellonian University Medical College.
Cardiol J. 2021;28(1):67-76. doi: 10.5603/CJ.a2020.0009. Epub 2020 Feb 10.
Late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) may reveal myocardial fibrosis which is associated with adverse clinical outcomes in patients undergoing implantable cardioverter-defibrillator (ICD) placement. At the same time, transmural LGE in the posterolateral wall is related to nonresponse to conventional cardiac resynchronization therapy (CRT). Herein, the aim was to assess the presence and determinants of LGE in CMR in heart failure (HF) with reduced ejection fraction.
Sixty-seven patients were included (17.9% female, aged 45 [29-60] years), who underwent LGE-CMR and had left ventricular ejection fraction (LVEF) as determined by echocardiography.
In HF patients with LVEF ≤ 35% (n = 29), ischemic and non-ischemic patterns of LGE were observed in 51.7% and 34.5% of patients, respectively. In controls (n = 38), these patterns were noted in 23.7% and 42.1% of patients, respectively. HF patients with LVEF ≤ 35% and transmural LGE in the posterolateral wall (31.0%) were characterized by older age, coronary artery disease (CAD) and previous myocardial infarction (MI) (61 ± 6 vs. 49 ± 16 years, p = 0.008, 100% vs. 40%, p = 0.003 and 78% vs. 25%, p = 0.014, respectively). In patients with LVEF ≤ 35%, LGE of any type, diagnosed in 86.2% of patients, was associated with CAD (68% vs. 0%, p = 0.02), while only trends were observed for its association with older age and previous MI (p = 0.08 and p = 0.12, respectively).
Among HF patients with LVEF ≤ 35%, clinical factors including older age, CAD, and previous MI are associated with transmural LGE in the posterolateral wall, while CAD is associated with LGE. This data may have potential implications for planning ICD and CRT placement procedures.
心脏磁共振（CMR）的晚期钆增强（LGE）可显示心肌纤维化，这与接受植入式心脏复律除颤器（ICD）植入的患者的不良临床结局相关。同时，心外膜侧壁的透壁性 LGE 与常规心脏再同步治疗（CRT）无反应有关。在此，目的是评估射血分数降低的心力衰竭（HF）患者中 CMR 的 LGE 存在及其决定因素。
纳入 67 名患者（17.9%为女性，年龄 45[29-60]岁），这些患者接受了 LGE-CMR 检查，且左心室射血分数（LVEF）通过超声心动图确定。
在 LVEF≤35%的 HF 患者（n=29）中，缺血性和非缺血性 LGE 模式分别在 51.7%和 34.5%的患者中观察到。在对照组（n=38）中，这些模式分别在 23.7%和 42.1%的患者中观察到。LVEF≤35%且心外膜侧壁透壁性 LGE（31.0%）的 HF 患者具有较老的年龄、冠状动脉疾病（CAD）和既往心肌梗死（MI）的特征（61±6 岁 vs. 49±16 岁，p=0.008；100% vs. 40%，p=0.003；78% vs. 25%，p=0.014）。在 LVEF≤35%的患者中，86.2%的患者被诊断为任何类型的 LGE，其与 CAD 相关（68% vs. 0%，p=0.02），而仅观察到其与年龄较大和既往 MI 之间存在趋势（p=0.08 和 p=0.12）。
在 LVEF≤35%的 HF 患者中，临床因素，包括年龄较大、CAD 和既往 MI，与心外膜侧壁的透壁性 LGE 相关，而 CAD 与 LGE 相关。这些数据可能对规划 ICD 和 CRT 植入程序具有潜在意义。
