Differentiation of Heart Failure Related to Dilated Cardiomyopathy and Coronary Artery Disease Using Gadolinium-Enhanced Cardiovascular Magnetic Resonance

Abstract

Background-Heart failure treatment depends partly on the underlying cause of the disease. We evaluated cardiovascular magnetic resonance (CMR) for the problem of differentiating dilated cardiomyopathy (DCM) from left ventricular (LV) dysfunction caused by coronary artery disease (CAD). Methods and Results-Late gadolinium enhancement with CMR was performed in 90 patients with heart failure and LV systolic dysfunction (63 patients with DCM and unobstructed coronary arteries and 27 with significant CAD at angiography). We also studied 15 control subjects with no coronary risk factors and/or unobstructed coronary arteries. None (0%) of the control subjects had myocardial gadolinium enhancement; however, all patients (100%) with LV dysfunction and CAD had enhancement, which was subendocardial or transmural. In patients with DCM, there were 3 findings: no enhancement (59%); myocardial enhancement indistinguishable from the patients with CAD (13%); and patchy or longitudinal striae of midwall enhancement clearly different from the distribution in patients with CAD (28%). Conclusions-Gadolinium CMR is a powerful technique to distinguish DCM from LV dysfunction related to CAD and yields new insights in DCM. These data suggest that using the coronary angiogram as the arbiter for the presence of LV dysfunction caused by CAD could have lead to an incorrect assignment of DCM cause in 13% of patients, possibly because of coronary recanalization after infarction. The midwall myocardial enhancement in patients with DCM is similar to the fibrosis found at autopsy; it has not previously been visualized in vivo and warrants further investigation. CMR may become a useful alternative to routine coronary angiography in the diagnostic workup of DCM.

Myocardial Damage Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Uncommon in Peripartum Cardiomyopathy

“…LGE can detect foci of myocardial damage as small as 0.7 g of myocardial tissue 28. In the absence of coronary artery disease associated with ischemic cardiomyopathy,29 LGE can likely detect myocardial damage associated with vasospasm, embolization, cocaine, or recanalized myocardial infarction 30…”

Low-dose CT and cardiac MR for the diagnosis of coronary artery disease: accuracy of single and combined approaches

“…Thus, it is the rule to combine these two CMR-techniques for improving the non-invasive detection of CAD [16]. It is important however to recognize that LGE can be caused by other diseases apart from CAD, such as hypertrophic or dilated cardiomyopathy [21,22]. Also, unrecognized myocardial infarction as depicted by LGE can occur as the result of a spontaneous thrombolysis and recannulation of an acute coronary lesion [23].…”

Can late gadolinium enhancement by cardiovascular magnetic resonance identify coronary artery disease as the etiology of new onset congestive heart failure?

“…Late gadolinium enhancement (LGE) is a magnetic resonance technique with proven efficacy for the detection of myocardial infarction [21] and identification of secondary causes of heart failure [22], including myocarditis [23,24]. Two recent studies have employed these techniques to evaluate the etiology of CHF [25,26]. Neither study specifically addressed patients with newly diagnosed heart failure.…”