Left ventricular geometric remodeling in relation to non-ischemic scar pattern on cardiac magnetic resonance imaging

Abstract

Purpose Left ventricular (LV) remodeling and myocardial fibrosis have been linked to adverse heart failure outcomes. Mid wall late gadolinium enhancement (MW-LGE) on cardiac magnetic resonance (CMR) imaging is well-associated with non-ischemic cardiomyopathy (NICM), but prevalence in ischemic cardiomyopathy (ICM) and association with remodeling are unknown. Methods The population comprised patients with systolic dysfunction (LVEF≤40%). CMR was used to identify MW-LGE, conventionally defined as fibrosis of the mid-myocardial or epicardial aspect of the LV septum. Results 285 patients were studied. MW-LGE was present in 12%, and was 10-fold more common with NICM (32%) vs. ICM (3%, p<0.001). However, owing to higher prevalence of ICM, 15% of patients with MW-LGE had ICM. LV wall stress was higher (p=0.02) among patients with, vs. those without, MW-LGE despite similar systolic blood pressure (p=0.24). In multivariate analysis, MW-LGE was associated with CMR-quantified LV end-diastolic volume (p=0.03) independent of LVEF and mass. Incorporation of clinical and imaging variables demonstrated MW-LGE to be associated with higher LV end-diastolic volume (OR=1.13 [CI 1.004–1.27] per 10 ml/m2, p=0.04) after controlling for presence of NICM (OR=16.0 [CI 5.8–44.1], p<0.001). Conclusions While more common in NICM, MW-LGE can occur in ICM and is a marker of LV chamber dilation irrespective of cardiomyopathic etiology.

Left ventricular geometry predicts optimal response to percutaneous mitral repair via MitraClip: Integrated assessment by two‐ and three‐dimensional echocardiography

“…It is also possible that myocardial tissue properties may impact this process due to increased LV stiffness as induced by sub‐valvular infarction or non‐ischemic fibrosis. Consistent with this, prior studies by our group have shown focal non‐ischemic fibrosis to increase in proportion to LV dilation, and other studies have shown extracellular volume (a marker of diffuse fibrosis) to increase with adverse LV remodeling . Whereas our study employed echo to assess LV remodeling, our observed association between LV dilation and residual MR, as well as known associations between dilation and fibrosis support the need for further research using MRI or other methods to test the modulating impact of myocardial fibrosis as a determinant of recurrent and/or residual MR after MClp.…”

Left ventricular shape predicts different types of cardiovascular events in the general population

“…LV end-diastolic and end-systolic volume indices as well as chamber diameters are also markers of HF and LVremodelling 6 7. In addition, the evaluation of LV chamber shape has been identified as an important marker of remodelling processes in patients with mitral regurgitation8 non-ischaemic cardiomyopathy9 and myocardial infarction (MI) 10 11. However, the ability of LV chamber shape to predict different types of CV events in an asymptomatic population free of CV disease is incompletely understood.…”

Cardiovascular imaging 2014 in the International Journal of Cardiovascular Imaging

“…The extracellular volume fraction thresholds corresponding to myocardial lesion detection in patients with myocardial infarction or hypertrophic cardiomyopathy was determined by Hwang et al [28]. Midwall LGE was found to be common in a series of patients with non-ischemic cardiomyopathy but occasionally observed in patients presenting with ischemic cardiomyopathy [29]. No relation was found for the presence of microvolt T-wave alternans, an ECG marker of risk of sudden death, for either the transmurality or extent of scar in patients with ischemic or dilated cardiomyopathy [30].…”