Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension

Freed, Benjamin H.; Gomberg‐Maitland, Mardi; Chandra, Sonal; Mor‐Avi, Victor; Rich, Stuart; Archer, Stephen L.; Jamison, Ernest; Lang, Roberto M.; Patel, Amit R.

doi:10.1186/1532-429x-14-11

Cited by 193 publications

(140 citation statements)

References 26 publications

(30 reference statements)

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“…An expanding literature supports a significant association between the presence of myocardial fibrosis by LGE imaging and clinically relevant cardiovascular outcomes. 6,8,14,15,[26][27][28][29] These investigations have examined a range of cardiomyopathy states but only few have focused on the prediction of arrhythmic among those with systolic dysfunction. Among patients with idiopathic NICM, 3 studies to date have reported an association between midwall striae hyperenhancement and future arrhythmic events.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, common disease associations include subendocardial hyperenhancement is associated with ischemic cardiomyopathy (ICM), midwall striae hyperenhancement with dilated non-ICM (NICM), midwall patchy hyperenhancement with hypertrophic cardiomyopathy, subepicardial hyperenhancement with myocarditis or sarcoidosis, right ventricular insertion site hyperenhancement with pulmonary hypertension, and diffuse hyperenhancement with amyloidosis. 13,14 Indeed, within these respective cohorts, some patterns of hyperenhancement have shown prognostic significance for the prediction of future cardiovascular events. [6][7][8]15 Recent studies support that specific patterns of hyperenhancement may not be isolated to clinically defined patient cohorts.…”

Section: Clinical Perspective On P 600mentioning

confidence: 99%

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Prevalence of Myocardial Fibrosis Patterns in Patients With Systolic Dysfunction

Almehmadi

Joncas

Nevis

et al. 2014

Circ: Cardiovascular Imaging

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Background-Late gadolinium enhancement-cardiac magnetic resonance is increasingly performed in patients with systolic dysfunction. Numerous patterns of fibrosis are commonly reported among this population. However, the relative prevalence and prognostic significance of these findings remains uncertain. Methods and Results-Three hundred eighteen consecutive patients referred for late gadolinium enhancement-cardiac magnetic resonance and a left ventricular ejection fraction <55% were followed up for the primary end point of sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy. Late gadolinium enhancement images were blindly interpreted for the presence of 6 distinct pattern(s) of myocardial fibrosis in addition to signal threshold-based quantification of total fibrosis volume. The mean age and left ventricular ejection fraction of participants were 62.0±12.9 years and 32.6±11.9%, respectively. Any pattern of myocardial fibrosis was seen in 248 patients (78%) with ≥2 patterns present in 25% of patients. During follow-up (median of 467 days), 49 patients (15%) had a primary outcome. After adjustment for left ventricular ejection fraction, cardiomyopathy pathogenesis, and total fibrosis volume, the presence of a midwall striae pattern of fibrosis was an independent predictor of sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy with a hazard ratio of 2.4 (95% confidence interval, 1.2-4.6; P=0.01); this finding is present in 30% of patients with nonischemic and 15% of patients with ischemic cardiomyopathy. Cumulative event rate was significantly higher among those with midwall striae, particularly among those with a left ventricular ejection fraction >35% (40% versus 6%; P=0.005). Conclusions-Patients with systolic dysfunction frequently demonstrate multiple patterns of myocardial fibrosis. Of these, a midwall striae pattern of fibrosis is the strongest independent predictor of sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy. (Circ Cardiovasc Imaging. 2014;7:593-600.)

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Perspective On P 600mentioning

confidence: 99%

Prevalence of Myocardial Fibrosis Patterns in Patients With Systolic Dysfunction

Almehmadi

Joncas

Nevis

et al. 2014

Circ: Cardiovascular Imaging

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“…36 One recent study was able to predict survival in patients with PAH based on the RV ejection fraction computed from CMR. 37 A more recent multicenter study demonstrated the feasibility of using CMR to track changes in RV size and function in response to 12 months of PAH-specific therapy. Taken together, these findings hold promise for the increased use of CMR protocols in both clinical trials and practice.…”

Section: Cardiac Mrimentioning

confidence: 99%

Clinical Diagnosis of Pulmonary Hypertension

Rich

2014

Circulation

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104

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1820T here has been an increased recognition of pulmonary hypertension (PH) in clinical practice over the past 30 years. It is likely that this rise in PH diagnoses is attributable to multiple factors, including increased awareness by clinicians, the routine use of diagnostic tools such as Doppler echocardiography, and the availability and marketing of the many PH-specific drugs.1 Although the increased awareness of the disease should be viewed as a favorable development, the unintended consequences include overdiagnosis, misclassification, and at times indiscriminate use of expensive, PH-specific drugs. In this review, we address the epidemiology, prognosis, and updated clinical classification of PH. We then focus on the diagnostic approach to the patient with suspected PH with an emphasis placed on highlighting key pearls for the clinician to consider. Finally, we review an evolving conceptual framework of viewing the pulmonary vasculature and the right ventricle as a single, coupled cardiopulmonary unit.

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“…Discussions centered on trials conducted under United States regulatory guidance because of the earlier passage of pediatric legislative initiatives, but we believe our recommendations are broadly applicable to all pediatric cardiovascular trials. Summary recommendations specific to individual therapeutic areas are provided in Table 2,29, 30, 31 with subsequent sections focusing on more generalized recommendations. Although our discussions focused on pediatric cardiovascular drug trial development, many of the recommendations pertain to other pediatric subspecialties, where similar challenges exist.…”

Section: Approaches To Improving Clinical Trials In Children With Carmentioning

confidence: 99%

Recommendations to Enhance Pediatric Cardiovascular Drug Development: Report of a Multi‐Stakeholder Think Tank

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et al. 2018

JAHA

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Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension

Cited by 193 publications

References 26 publications

Prevalence of Myocardial Fibrosis Patterns in Patients With Systolic Dysfunction

Prevalence of Myocardial Fibrosis Patterns in Patients With Systolic Dysfunction

Clinical Diagnosis of Pulmonary Hypertension

Recommendations to Enhance Pediatric Cardiovascular Drug Development: Report of a Multi‐Stakeholder Think Tank

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