Liao Ting-Wei Ernie, Xu Lingyu, Khoshknab Mirmilad Pourmousavi, Mather Paul J, Bravo Paco E, Desjardins Benoit, Nazarian Saman
Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Section of Cardiomyopathy, Division of Cardiovascular Medicine, Department of Medicine , University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
J Interv Card Electrophysiol. 2025 May 6. doi: 10.1007/s10840-025-02042-7.
Dilated cardiomyopathy (DCM) and cardiac sarcoidosis (CS) manifest unique late gadolinium enhancement (LGE) patterns on cardiac magnetic resonance (CMR), indicative of different myocardial scar distributions. However, the overlap in these patterns due to their lack of specificity complicates differentiation. This study introduces a novel quantitative method employing z-score analysis of LGE-CMR intensity to objectively compare the spatial distribution of LGE intensity between DCM and CS.
This retrospective study included 22 NICM patients (13 DCM, 9 CS) who underwent CMR before electrophysiology study from November 2018 to May 2023. LGE images were delineated into sub-endocardial, mid-myocardial, and sub-epicardial layers across anterior, lateral, inferior, and septal walls using the AHA 17-segment model. CMR signal intensities were standardized to z-scores (z = (x - μ)/σ), with x as the signal intensity for a specific myocardial segment, and μ and σ as the mean and SD for all LV myocardial segments, to map regional intensity variations.
Compared to DCM, CS patients exhibited significantly higher CMR signal intensity z-scores in the septum (β = 0.32, p = 0.009), particularly in the endocardial third of the right ventricular (RV) side (β = 0.56, p = 0.001). A z-score greater than 0.40 in this area was associated with a CS diagnosis, with an area under the ROC curve of 0.692 in fivefold cross-validation.
Patients with CS exhibit higher affinity for contrast in the septum, particularly on the RV endocardium. Standardized analysis of CMR signal intensities provides a novel, quantitative method for distinguishing CS from DCM, with the former exhibiting higher CMR signal intensity z-scores in the septum.
扩张型心肌病（DCM）和心脏结节病（CS）在心脏磁共振成像（CMR）上表现出独特的延迟钆增强（LGE）模式，提示不同的心肌瘢痕分布。然而，由于这些模式缺乏特异性，其重叠使得鉴别变得复杂。本研究引入了一种新的定量方法，采用LGE-CMR强度的z分数分析来客观比较DCM和CS之间LGE强度的空间分布。
这项回顾性研究纳入了2018年11月至2023年5月期间在进行电生理研究前接受CMR检查的22例非缺血性心肌病（NICM）患者（13例DCM，9例CS）。使用美国心脏协会（AHA）17节段模型，将LGE图像在前壁、侧壁、下壁和间隔壁划分为心内膜下、心肌中层和心外膜下层。将CMR信号强度标准化为z分数（z = (x - μ)/σ），其中x为特定心肌节段的信号强度，μ和σ为所有左心室心肌节段的均值和标准差，以绘制区域强度变化图。
与DCM相比，CS患者在间隔处的CMR信号强度z分数显著更高（β = 0.32，p = 0.009），尤其是在右心室（RV）侧的心内膜三分之一处（β = 0.56，p = 0.001）。该区域z分数大于0.40与CS诊断相关，在五折交叉验证中，受试者工作特征曲线（ROC）下面积为0.692。
CS患者在间隔处，特别是在RV心内膜处对造影剂具有更高的亲和力。CMR信号强度的标准化分析为区分CS和DCM提供了一种新的定量方法，前者在间隔处表现出更高的CMR信号强度z分数。
