Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Cardiology Reports
Published in: Current Cardiology Reports 1/2013

01-01-2013 | Cardiac PET, CT, and MRI (S Achenbach, Section Editor)

The Prognostic Value of Late Gadolinium Enhancement CMR in Nonischemic Cardiomyopathies

Authors: Theodoros D. Karamitsos, Stefan Neubauer

Published in: Current Cardiology Reports | Issue 1/2013

Login to get access

Abstract

Cardiovascular magnetic resonance (CMR) is a valuable clinical tool in everyday practice providing additional information to echocardiography. The late gadolinium enhancement (LGE) technique is now part of nearly every CMR protocol and enables in-vivo tissue characterization in ischemic (identification of scaring due to infarction) and many nonischemic cardiomyopathies (identification of regional or patchy fibrosis or infiltration). This review presents the evolving prognostic evidence base of LGE-CMR with a particular focus on nonischemic cardiomyopathies. Novel methods to assess diffuse myocardial fibrosis such as pre- and post-contrast T1-mapping are also discussed.
Literature
1.
Pohost GM. The history of cardiovascular magnetic resonance. JACC Cardiovasc Imaging. 2008;1:672–8.PubMedCrossRef
2.
Karamitsos TD, Francis JM, Myerson S, Selvanayagam JB, Neubauer S. The role of cardiovascular magnetic resonance imaging in heart failure. J Am Coll Cardiol. 2009;54:1407–24.PubMedCrossRef
3.
Kim RJ, Chen EL, Lima JA, Judd RM. Myocardial gd-dtpa kinetics determine mri contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction. Circulation. 1996;94:3318–26.PubMedCrossRef
4.
Kim RJ, Fieno DS, Parrish TB, Harris K, Chen EL, Simonetti O, et al. Relationship of mri delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation. 1999;100:1992–2002.PubMedCrossRef
5.
Wagner A, Mahrholdt H, Holly TA, Elliott MD, Regenfus M, Parker M, et al. Contrast-enhanced mri and routine single photon emission computed tomography (spect) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet. 2003;361:374–9.PubMedCrossRef
6.
•• Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000;343:1445–53. Landmark study which established the use of late gadolinium enhancement to predict regional function post revascularization.
7.
Selvanayagam JB, Kardos A, Francis JM, Wiesmann F, Petersen SE, Taggart DP, et al. Value of delayed-enhancement cardiovascular magnetic resonance imaging in predicting myocardial viability after surgical revascularization. Circulation. 2004;110:1535–41.PubMedCrossRef
8.
• Pegg TJ, Selvanayagam JB, Jennifer J, Francis JM, Karamitsos TD, Dall'Armellina E, et al. Prediction of global left ventricular functional recovery in patients with heart failure undergoing surgical revascularisation, based on late gadolinium enhancement cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2010;12:56. An important paper which describes the ability of late gadolinium enhancement to predict not only regional but also global recovery of function post revascularization.
9.
Cheong BY, Muthupillai R, Wilson JM, Sung A, Huber S, Amin S, et al. Prognostic significance of delayed-enhancement magnetic resonance imaging: survival of 857 patients with and without left ventricular dysfunction. Circulation. 2009;120:2069–76.PubMedCrossRef
10.
Kwon DH, Halley CM, Carrigan TP, Zysek V, Popovic ZB, Setser R, et al. Extent of left ventricular scar predicts outcomes in ischemic cardiomyopathy patients with significantly reduced systolic function: a delayed hyperenhancement cardiac magnetic resonance study. JACC Cardiovasc Imaging. 2009;2:34–44.PubMedCrossRef
11.
Kwong RY, Chan AK, Brown KA, Chan CW, Reynolds HG, Tsang S, et al. Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation. 2006;113:2733–43.PubMedCrossRef
12.
Kwong RY, Sattar H, Wu H, Vorobiof G, Gandla V, Steel K, et al. Incidence and prognostic implication of unrecognized myocardial scar characterized by cardiac magnetic resonance in diabetic patients without clinical evidence of myocardial infarction. Circulation. 2008;118:1011–20.PubMedCrossRef
13.
Rahimi K, Banning AP, Cheng AS, Pegg TJ, Karamitsos TD, Channon KM, et al. Prognostic value of coronary revascularisation-related myocardial injury: a cardiac magnetic resonance imaging study. Heart. 2009;95:1937–43.PubMedCrossRef
14.
Schmidt A, Azevedo CF, Cheng A, Gupta SN, Bluemke DA, Foo TK, et al. Infarct tissue heterogeneity by magnetic resonance imaging identifies enhanced cardiac arrhythmia susceptibility in patients with left ventricular dysfunction. Circulation. 2007;115:2006–14.PubMedCrossRef
15.
Yan AT, Shayne AJ, Brown KA, Gupta SN, Chan CW, Luu TM, et al. Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality. Circulation. 2006;114:32–9.PubMedCrossRef
16.
Karamitsos TD, Francis JM, Neubauer S. The current and emerging role of cardiovascular magnetic resonance in the diagnosis of nonischemic cardiomyopathies. Prog Cardiovasc Dis. 2011;54:253–65.PubMedCrossRef
17.
Lehrke S, Lossnitzer D, Schob M, Steen H, Merten C, Kemmling H, et al. Use of cardiovascular magnetic resonance for risk stratification in chronic heart failure: prognostic value of late gadolinium enhancement in patients with non-ischaemic dilated cardiomyopathy. Heart. 2011;97:727–32.PubMedCrossRef
18.
McCrohon JA, Moon JC, Prasad SK, McKenna WJ, Lorenz CH, Coats AJ, et al. Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation. 2003;108:54–9.PubMedCrossRef
19.
•• Assomull RG, Prasad SK, Lyne J, Smith G, Burman ED, Khan M, et al. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol. 2006;48:1977–85. An important paper which describes the prognostic value of midwall fibrosis in patients with dilated cardiomyopathy.
20.
Nazarian S, Bluemke DA, Lardo AC, Zviman MM, Watkins SP, Dickfeld TL, et al. Magnetic resonance assessment of the substrate for inducible ventricular tachycardia in nonischemic cardiomyopathy. Circulation. 2005;112:2821–5.PubMedCrossRef
21.
Wu KC, Weiss RG, Thiemann DR, Kitagawa K, Schmidt A, Dalal D, et al. Late gadolinium enhancement by cardiovascular magnetic resonance heralds an adverse prognosis in nonischemic cardiomyopathy. J Am Coll Cardiol. 2008;51:2414–21.PubMedCrossRef
22.
Iles L, Pfluger H, Lefkovits L, Butler MJ, Kistler PM, Kaye DM, et al. Myocardial fibrosis predicts appropriate device therapy in patients with implantable cardioverter-defibrillators for primary prevention of sudden cardiac death. J Am Coll Cardiol. 2011;57:821–8.PubMedCrossRef
23.
Leong DP, Chakrabarty A, Shipp N, Molaee P, Madsen PL, Joerg L, et al. Effects of myocardial fibrosis and ventricular dyssynchrony on response to therapy in new-presentation idiopathic dilated cardiomyopathy: insights from cardiovascular magnetic resonance and echocardiography. Eur Heart J. 2012;33:640–8.PubMedCrossRef
24.
Maron MS. Clinical utility of cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson. 2012;14:13.PubMedCrossRef
25.
Rudolph A, Abdel-Aty H, Bohl S, Boye P, Zagrosek A, Dietz R, et al. Noninvasive detection of fibrosis applying contrast-enhanced cardiac magnetic resonance in different forms of left ventricular hypertrophy relation to remodeling. J Am Coll Cardiol. 2009;53:284–91.PubMedCrossRef
26.
Maron MS, Appelbaum E, Harrigan CJ, Buros J, Gibson CM, Hanna C, et al. Clinical profile and significance of delayed enhancement in hypertrophic cardiomyopathy. Circ Heart Fail. 2008;1:184–91.PubMedCrossRef
27.
Adabag AS, Maron BJ, Appelbaum E, Harrigan CJ, Buros JL, Gibson CM, et al. Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance. J Am Coll Cardiol. 2008;51:1369–74.PubMedCrossRef
28.
Kwon DH, Setser RM, Popovic ZB, Thamilarasan M, Sola S, Schoenhagen P, et al. Association of myocardial fibrosis, electrocardiography and ventricular tachyarrhythmia in hypertrophic cardiomyopathy: a delayed contrast enhanced mri study. Int J Cardiovasc Imaging. 2008;24:617–25.PubMedCrossRef
29.
• O'Hanlon R, Grasso A, Roughton M, Moon JC, Clark S, Wage R, et al. Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2010;56:867–74. A study that assessed the prognostic value of late gadolinium enhancement in patients with hypertrophic cardiomyopathy.
30.
• Bruder O, Wagner A, Jensen CJ, Schneider S, Ong P, Kispert EM, et al. Myocardial scar visualized by cardiovascular magnetic resonance imaging predicts major adverse events in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 2010;56:875–87. A study that assessed the prognostic value of late gadolinium enhancement in patients with hypertrophic cardiomyopathy.
31.
Rubinshtein R, Glockner JF, Ommen SR, Araoz PA, Ackerman MJ, Sorajja P, et al. Characteristics and clinical significance of late gadolinium enhancement by contrast-enhanced magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Circ Heart Fail. 2010;3:51–8. A study that assessed the prognostic value of late gadolinium enhancement in patients with hypertrophic cardiomyopathy.
32.
Appelbaum E, Maron BJ, Adabag S, Hauser TH, Lesser JR, Haas TS, et al. Intermediate-signal-intensity late gadolinium enhancement predicts ventricular tachyarrhythmias in patients with hypertrophic cardiomyopathy. Circ Cardiovasc Imaging. 2012;5:78–85.PubMedCrossRef
33.
Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation. 2010;121:1533–41.PubMedCrossRef
34.
Hunold P, Wieneke H, Bruder O, Krueger U, Schlosser T, Erbel R, et al. Late enhancement: a new feature in mri of arrhythmogenic right ventricular cardiomyopathy? J Cardiovasc Magn Reson. 2005;7:649–55.PubMed
35.
Tandri H, Saranathan M, Rodriguez ER, Martinez C, Bomma C, Nasir K, et al. Noninvasive detection of myocardial fibrosis in arrhythmogenic right ventricular cardiomyopathy using delayed-enhancement magnetic resonance imaging. J Am Coll Cardiol. 2005;45:98–103.PubMedCrossRef
36.
Karamitsos TD, Neubauer S. Cardiovascular magnetic resonance in heart failure. Curr Cardiol Rep. 2011;13:210–9.PubMedCrossRef
37.
Childs H, Friedrich MG. Cardiovascular magnetic resonance imaging in myocarditis. Prog Cardiovasc Dis. 2011;54:266–75.PubMedCrossRef
38.
Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT, et al. Cardiovascular magnetic resonance in myocarditis: a jacc white paper. J Am Coll Cardiol. 2009;53:1475–87.PubMedCrossRef
39.
•• Grun S, Schumm J, Greulich S, Wagner A, Schneider S, Bruder O, et al. Long-term follow-up of biopsy-proven viral myocarditis: predictors of mortality and incomplete recovery. J Am Coll Cardiol. 2012;59:1604–15. This study assessed the prognostic value of late gadolinium enhancement in patients with myocarditis.
40.
• Austin BA, Tang WH, Rodriguez ER, Tan C, Flamm SD, Taylor DO, et al. Delayed hyper-enhancement magnetic resonance imaging provides incremental diagnostic and prognostic utility in suspected cardiac amyloidosis. JACC Cardiovasc Imaging. 2009;2:1369–77. This study assessed the prognostic value of late gadolinium enhancement in patients with amyloidosis.
41.
Maceira AM, Joshi J, Prasad SK, Moon JC, Perugini E, Harding I, et al. Cardiovascular magnetic resonance in cardiac amyloidosis. Circulation. 2005;111:186–93.PubMedCrossRef
42.
Syed IS, Glockner JF, Feng D, Araoz PA, Martinez MW, Edwards WD, et al. Role of cardiac magnetic resonance imaging in the detection of cardiac amyloidosis. JACC Cardiovasc Imaging. 2010;3:155–64.PubMedCrossRef
43.
Vogelsberg H, Mahrholdt H, Deluigi CC, Yilmaz A, Kispert EM, Greulich S, et al. Cardiovascular magnetic resonance in clinically suspected cardiac amyloidosis: noninvasive imaging compared to endomyocardial biopsy. J Am Coll Cardiol. 2008;51:1022–30.PubMedCrossRef
44.
Maceira AM, Prasad SK, Hawkins PN, Roughton M, Pennell DJ. Cardiovascular magnetic resonance and prognosis in cardiac amyloidosis. J Cardiovasc Magn Reson. 2008;10:54.PubMedCrossRef
45.
Patel AR, Klein MR, Chandra S, Spencer KT, Decara JM, Lang RM, et al. Myocardial damage in patients with sarcoidosis and preserved left ventricular systolic function: an observational study. Eur J Heart Fail. 2011;13(11):1231–7. doi:10.​1093/​eurjhf/​hfr099.
46.
Patel MR, Cawley PJ, Heitner JF, Klem I, Parker MA, Jaroudi WA, et al. Detection of myocardial damage in patients with sarcoidosis. Circulation. 2009;120:1969–77.PubMedCrossRef
47.
Smedema JP, Snoep G, van Kroonenburgh MP, van Geuns RJ, Dassen WR, Gorgels AP, et al. Evaluation of the accuracy of gadolinium-enhanced cardiovascular magnetic resonance in the diagnosis of cardiac sarcoidosis. J Am Coll Cardiol. 2005;45:1683–90.PubMedCrossRef
48.
Karamitsos TD, Myerson SG. The role of cardiovascular magnetic resonance in the evaluation of valve disease. Prog Cardiovasc Dis. 2011;54:276–86.PubMedCrossRef
49.
• Dweck MR, Joshi S, Murigu T, Alpendurada F, Jabbour A, Melina G, et al. Midwall fibrosis is an independent predictor of mortality in patients with aortic stenosis. J Am Coll Cardiol. 2011;58:1271–9. This study assessed the prognostic value of late gadolinium enhancement in patients with aortic stenosis.
50.
Blyth KG, Groenning BA, Martin TN, Foster JE, Mark PB, Dargie HJ, et al. Contrast enhanced-cardiovascular magnetic resonance imaging in patients with pulmonary hypertension. Eur Heart J. 2005;26:1993–9.PubMedCrossRef
51.
Shehata ML, Lossnitzer D, Skrok J, Boyce D, Lechtzin N, Mathai SC, et al. Myocardial delayed enhancement in pulmonary hypertension: pulmonary hemodynamics, right ventricular function, and remodeling. AJR Am J Roentgenol. 2011;196:87–94.PubMedCrossRef
52.
Freed BH, Gomberg-Maitland M, Chandra S, Mor-Avi V, Rich S, Archer SL, et al. Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension. J Cardiovasc Magn Reson. 2012;14:11.PubMedCrossRef
53.
Modell B, Khan M, Darlison M, Westwood MA, Ingram D, Pennell DJ. Improved survival of thalassaemia major in the uk and relation to t2* cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2008;10:42.PubMedCrossRef
54.
Kirk P, Roughton M, Porter JB, Walker JM, Tanner MA, Patel J, et al. Cardiac t2* magnetic resonance for prediction of cardiac complications in thalassemia major. Circulation. 2009;120:1961–8.PubMedCrossRef
55.
Kirk P, Carpenter JP, Tanner MA, Pennell DJ. Low prevalence of fibrosis in thalassemia major assessed by late gadolinium enhancement cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2011;13:8.PubMedCrossRef
56.
• White SK, Sado DM, Flett AS, Moon JC. Characterising the myocardial interstitial space: the clinical relevance of non-invasive imaging. Heart. 2012;98:773–9. Interesting review article which summarizes the role of CMR and other imaging modalities in the characterisation of myocardial interstitial space.
57.
Piechnik SK, Ferreira VM, Dall'armellina E, Cochlin LE, Greiser A, Neubauer S, et al. Shortened modified look-locker inversion recovery (shmolli) for clinical myocardial t1-mapping at 1.5 and 3 t within a 9 heartbeat breathhold. J Cardiovasc Magn Reson. 2010;12:69.PubMedCrossRef
58.
Dall'Armellina E, Piechnik SK, Ferreira VM, Si QL, Robson MD, Francis JM, et al. Cardiovascular magnetic resonance by non contrast t1-mapping allows assessment of severity of injury in acute myocardial infarction. J Cardiovasc Magn Reson. 2012;14:15.PubMedCrossRef
59.
Messroghli DR, Walters K, Plein S, Sparrow P, Friedrich MG, Ridgway JP, et al. Myocardial t1 mapping: application to patients with acute and chronic myocardial infarction. Magn Reson Med. 2007;58:34–40.PubMedCrossRef
60.
Ferreira VM, Piechnik SK, Dall'Armellina E, Karamitsos TD, Francis JM, Choudhury RP, et al. Non-contrast t1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to t2-weighted cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2012;14:42.PubMedCrossRef
61.
•• Flett AS, Hayward MP, Ashworth MT, Hansen MS, Taylor AM, Elliott PM, et al. Equilibrium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: preliminary validation in humans. Circulation. 2010;122:138–44. One of the first studies showing the ability of CMR to assess diffuse fibrosis in hypertrophic cardiomyopathy and aortic stenosis.
62.
Broberg CS, Chugh SS, Conklin C, Sahn DJ, Jerosch-Herold M. Quantification of diffuse myocardial fibrosis and its association with myocardial dysfunction in congenital heart disease. Circ-Cardiovasc Imaging. 2010;3:727–34.PubMedCrossRef
63.
• Jerosch-Herold M, Sheridan DC, Kushner JD, Nauman D, Burgess D, Dutton D, et al. Cardiac magnetic resonance imaging of myocardial contrast uptake and blood flow in patients affected with idiopathic or familial dilated cardiomyopathy. Am J Physiol Heart Circ Physiol. 2008;295:H1234–42. One of the first studies showing the ability of CMR to assess diffuse fibrosis in patients with dilated cardiomyopathy.
64.
Iles L, Pfluger H, Phrommintikul A, Cherayath J, Aksit P, Gupta SN, et al. Evaluation of diffuse myocardial fibrosis in heart failure with cardiac magnetic resonance contrast-enhanced t1 mapping. J Am Coll Cardiol. 2008;52:1574–80.PubMedCrossRef
Metadata
Title
The Prognostic Value of Late Gadolinium Enhancement CMR in Nonischemic Cardiomyopathies
Authors
Theodoros D. Karamitsos
Stefan Neubauer
Publication date
01-01-2013
Publisher
Current Science Inc.
Published in
Current Cardiology Reports / Issue 1/2013
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-012-0326-2

Other articles of this Issue 1/2013

Current Cardiology Reports 1/2013 Go to the issue

Diabetes and Cardiovascular Disease (S Malik, Section Editor)

Cardiovascular Effects of Anti-Diabetic Medications in Type 2 Diabetes Mellitus

New Therapies for Cardiovascular Disease (K Mahaffey, Section Editor)

Impediments to Adherence to Post Myocardial Infarction Medications

New Therapies for Cardiovascular Disease (K Mahaffey, Section Editor)

Platelet Function Monitoring and Clopidogrel

Cardiac PET, CT, and MRI (S Achenbach, Section Editor)

Imaging of Inflammation and Calcification in Aortic Stenosis

Diabetes and Cardiovascular Disease (S Malik, Section Editor)

Percutaneous Versus Surgical Interventions for Coronary Artery Disease in Those with Diabetes Mellitus

Cardiac PET, CT, and MRI (S Achenbach, Section Editor)

Transcatheter Aortic Valve Repair, Imaging, and Electronic Imaging Health Record

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits