Left ventricular geometric remodeling in relation to non-ischemic scar pattern on cardiac magnetic resonance imaging
Magnetic Resonance Imaging, Cine
Ventricular Dysfunction, Left
Ventricular Function, Left
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. The population comprised patients with systolic dysfunction [LV ejection fraction (LVEF ≤ 40 %)]. CMR was used to identify MW-LGE, conventionally defined as fibrosis of the mid-myocardial or epicardial aspect of the LV septum. 285 patients were studied. MW-LGE was present in 12 %, and was tenfold more common with NICM (32 %) versus 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, versus 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/m(2), p = 0.04) after controlling for presence of NICM (OR 16.0, CI 5.8-44.1, p < 0.001). While more common in NICM, MW-LGE can occur in ICM and is a marker of LV chamber dilation irrespective of cardiomyopathic etiology.