Prognostic implications of late gadolinium enhancement at the right ventricular insertion point in patients with non-ischemic dilated cardiomyopathy: A multicenter retrospective cohort study

Yi, Jeong Eun; Park, Junbeom; Lee, Hye Jeong; Shin, Dong Geum; Kim, Yookyung; Kim, Minsuk; Kwon, Kihwan; Pyun, Wook Bum; Kim, Young Jin; Joung, Boyoung

doi:10.1371/journal.pone.0208100

Cited by 31 publications

(21 citation statements)

References 36 publications

(41 reference statements)

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“…We also found that RV insertion site LGE was common. Right ventricular insertion site LGE can be seen in other non-ischemic cardiomyopathies (NICM), and is frequently seen in patients with hypertrophic cardiomyopathy [ 35 ], and an analysis of patients with other NICM found that patients with this pattern did not have significantly increased adverse outcomes [ 36 ]. Right ventricular insertion site LGE with histopathological evidence of inflammation and fibrosis has been described in a case report of a patient with ICI myocarditis from our institution [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity

et al. 2021

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Background Immune checkpoint inhibitors (ICIs) are highly effective in treating cancer; however, cardiotoxicity can occur, including myocarditis. Cardiac magnetic resonance (CMR) imaging is useful for evaluation of myocarditis, although it has not been well studied in ICI cardiotoxicity. Methods We identified patients referred for CMR evaluation of ICI cardiotoxicity from September 2015 through September 2019. We assessed structural and functional parameters, feature tracking (FT) left ventricular and atrial strain, T2- weighted ratios and quantitative late gadolinium enhancement (LGE). We also applied the Updated Lake Louise Criteria for diagnosis of myocarditis. Results Of the 20 patients referred, the median left ventricular ejection fraction (LVEF) was 52.5% ± 19.1 and 50% had a normal LVEF (≥53%). FT strain analysis revealed an average abnormal global longitudinal strain (GLS) of −9.8%± 4.2%. In patients with a normal LVEF, the average GLS remained depressed at −12.3%± 2.4%. In all patients, GLS demonstrated a significant negative correlation with LVEF (rs = −0.64, p 0.002). Sixteen patients (80%) had presence of LGE (14 non-ischemic pattern and 2 ischemic). Percent LGE did not correlate with any CMR parameters and notably did not correlate with LVEF (rs = −0.29, p = 0.22) or GLS (rs = 0.10, p = 0.67), highlighting the value of tissue characterization beyond functional assessment. Nine patients (45%) met full Updated Lake Louise Criteria and 85% met at least one criterion, suggestive of myocarditis in the correct clinical context. Thirteen patients (65%) were treated for ICI-associated myocarditis and, of these, 54% (n = 7) had recovery of LVEF to normal. There was no correlation between LVEF (p = 0.47), GLS (0.89), or % LGE (0.15) and recovery of LVEF with treatment. Conclusion In patients with suspected ICI cardiotoxicity, CMR is an important diagnostic tool, even in the absence of overt left ventricular dysfunction, as abnormalities in left ventricular strain, T2 signal and LGE can identifying disease.

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Section: Discussionmentioning

confidence: 99%

Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity

et al. 2021

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“…In addition, our study population showed a high prevalence of patchy LGE, particularly at right ventricular insertion point (RVIP-LGE) that is generally considered to be nonspecific in patients with hypertrophic cardiomyopathy 34 . However, its clinical implication in other medical conditions still remains unclear, and in a recently published our study including 360 NICM patients, we found that patients with RVIP-LGE had a worse prognosis than those with absence of LGE 35 . Although tissue characteristics of RVIP-LGE was not confirmed by endomyocardial biopsy in this study, the image quality was checked, and the potential pitfalls and artifacts mimicking myocardial scar were also excluded by two experienced radiologists.…”

Section: Discussionmentioning

confidence: 62%

Additive prognostic value of red cell distribution width over late gadolinium enhancement on CMR in patients with non-ischemic dilated cardiomyopathy

Lee

Kim

et al. 2020

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elevated red cell distribution width (RDW) and late gadolinium enhancement on cardiac magnetic resonance (LGe-cMR) are both poor prognostic factors. this study examined the relationship between RDW and LGe-cMR characteristics in patients with non-ischemic dilated cardiomyopathy (nicM), and investigated whether the additive prognostic value of RDW as an integrative systemic factor over LGe-CMR exists or not. A total of consecutive 378 patients who underwent CMR at two general hospitals in South Korea were retrospectively analyzed. the primary endpoint was a composite of all-cause death, hospitalizations due to worsening heart failure and major arrhythmic events. During a mean follow-up period of 40.8 months, 151 (39.9%) patients experienced primary endpoints. The RDW value was significantly higher in patients with LGE than in those without LGE (13.7 ± 1.5% vs. 13.3 ± 1.4%, p = 0.034), but it was not associated with the extent or distribution patterns of the LGE. Addition of RDW into the model with clinical risk factors and LGE-CMR characteristics led to a significant improvement in the prediction of worse outcomes (χ 2 increased from 73 to 82; p = 0.023). RDW could provide incremental predictive value for adverse clinical events beyond LGe-cMR data in nicM patients.

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“…First, the optimal method for LGE quantification is not unified. Recently, the 5 SD, 6 SD, and full-width half maximum (FWHM) threshold methods are widely used to quantify LGE ( 19 20 21 22 ). The FWHM threshold method measures smaller scars than the two SD techniques, but there are no comparisons to a gold standard of pathological examinations in NICM patients.…”

Section: Discussionmentioning

confidence: 99%

The Extent of Late Gadolinium Enhancement Can Predict Adverse Cardiac Outcomes in Patients with Non-Ischemic Cardiomyopathy with Reduced Left Ventricular Ejection Fraction: A Prospective Observational Study

et al. 2021

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Objective The clinical course of an individual patient with heart failure is unpredictable with left ventricle ejection fraction (LVEF) only. We aimed to evaluate the prognostic value of cardiac magnetic resonance (CMR)-derived myocardial fibrosis extent and to determine the cutoff value for event-free survival in patients with non-ischemic cardiomyopathy (NICM) who had severely reduced LVEF. Materials and Methods Our prospective cohort study included 78 NICM patients with significantly reduced LV systolic function (LVEF < 35%). CMR images were analyzed for the presence and extent of late gadolinium enhancement (LGE). The primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, heart transplantation, implantable cardioverter-defibrillator discharge for major arrhythmia, and hospitalization for congestive heart failure within 5 years after enrollment. Results A total of 80.8% (n = 63) of enrolled patients had LGE, with the median LVEF of 25.4% (19.8–32.4%). The extent of myocardial scarring was significantly higher in patients who experienced MACE than in those without any cardiac events (22.0 [5.5–46.1] %LV vs. 6.7 [0–17.1] %LV, respectively, p = 0.008). During follow-up, 51.4% of patients with LGE ≥ 12.0 %LV experienced MACE, along with 20.9% of those with LGE ≤ 12.0 %LV (log-rank p = 0.001). According to multivariate analysis, LGE extent more than 12.0 %LV was independently associated with MACE (adjusted hazard ratio, 6.71; 95% confidence interval, 2.54–17.74; p < 0.001). Conclusion In NICM patients with significantly reduced LV systolic function, the extent of LGE is a strong predictor for long-term adverse cardiac outcomes. Event-free survival was well discriminated with an LGE cutoff value of 12.0 %LV in these patients.

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Prognostic implications of late gadolinium enhancement at the right ventricular insertion point in patients with non-ischemic dilated cardiomyopathy: A multicenter retrospective cohort study

Cited by 31 publications

References 36 publications

Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity

Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity

Additive prognostic value of red cell distribution width over late gadolinium enhancement on CMR in patients with non-ischemic dilated cardiomyopathy

The Extent of Late Gadolinium Enhancement Can Predict Adverse Cardiac Outcomes in Patients with Non-Ischemic Cardiomyopathy with Reduced Left Ventricular Ejection Fraction: A Prospective Observational Study

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