Korean Circ J.  2016 Jan;46(1):41-47. 10.4070/kcj.2016.46.1.41.

Concordant and Discordant Cardiac Magnetic Resonance Imaging Delayed Hyperenhancement Patterns in Patients with Ischemic and Non-Ischemic Cardiomyopathy

• Kim EK
• Chang SA
• Choi JO
• Glockner J
• Shapiro B
• Choe YH
• Fine N
• Jang SY
• Kim SM
• Miller W
• Lee SC
• Oh JK

• KMID: 2223768
• DOI: http://doi.org/10.4070/kcj.2016.46.1.41

Abstract

BACKGROUND AND OBJECTIVES
The diagnosis of ischemic (ICM) and non-ischemic cardiomyopathy (NICM) is conventionally determined by the presence or absence of coronary artery disease (CAD) in the setting of a reduced left systolic function. However the presence of CAD may not always indicate that the actual left ventricular (LV) dysfunction mechanism is ischemia, as other non-ischemic etiologies can be responsible. We investigated patterns of myocardial fibrosis using delayed hyperenhancement (DHE) on cardiac magnetic resonance (CMR) in ICM and NICM.
SUBJECTS AND METHODS
Patients with systolic heart failure who underwent a CMR were prospectively analyzed. The heart failure diagnosis was based on the modified Framingham criteria and LVEF <35%. LV dysfunction was classified as ICM or NICM based on coronary anatomy.
RESULTS
A total of 101 subjects were analyzed; 34 were classified as ICM and 67 as NICM. The DHE pattern was concordant with the conventional diagnosis in 27 (79.4%) of the patients with ICM and 62 (92.5%) of the patients with NCIM. A discordant NICM DHE pattern was present in 8.8% of patients with ICM, and an ICM pattern was detected 6.0% of the patients with NICM. Furthermore, 11.8% of the patients with ICM and 1.5% of those with NICM demonstrated a mixed pattern.
CONCLUSION
A subset of patients conventionally diagnosed with ICM or NICM based on coronary anatomy demonstrated a discordant or mixed DHE pattern. CMR-DHE imaging can be helpful to determine the etiology of heart failure in patients with persistent LV systolic dysfunction.

Keyword

Cardiomyopathies; Magnetic resonance imaging; Cardiac imaging technique

MeSH Terms

Cardiac Imaging Techniques
Cardiomyopathies*
Coronary Artery Disease
Diagnosis
Fibrosis
Heart Failure
Heart Failure, Systolic
Humans
Ischemia
Magnetic Resonance Imaging*
Prospective Studies

Figure

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  Fig. 1 Delayed hyperenhancement pattern on CMR in patients with cardiomyopathy and severe left ventricular systolic dysfunction. CMR: cardiac magnetic resonance, ICM: ischemic cardiomyopathy, NICM: nonischemic cardiomyopathy.

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  Fig. 2 Representative cases of ICM patients with NICM or mixed patterns of delayed hyperenhancement on CMR. (A) The basal mid-septum is enhanced linearly (pattern of non-ischemic cardiomyopathy) on this 10-min delayed short axis image (arrowheads). (B) Basal myocardium shows linear enhancement of the mid-septum (arrowheads) and transmural enhancement (black arrows) (mixed pattern) on this 10-min delayed short axis image. ICM: ischemic cardiomyopathy, NICM: non-ischemic cardiomyopathy, CMR: cardiac magnetic resonance.

• 

  Fig. 3 Representative cases of NICM patients ICM or mixed patterns of delayed hyperenhancement on CMR. (A) Lateral segment of the mid myocardium demonstrates subendocardial delayed hyperenhancement (pattern of ischemic cardiomyopathy, black arrows) on this 10-min delayed short axis image. (B) Multiple focal patchy hyperenhancement in the septum (arrowheads) and transmural hyperenhancement (black arrows) of the inferolateral segment of the basal myocardium are evident in this 10-min delayed short axis image. NICM: non-ischemic cardiomyopathy, ICM: ischemic cardiomyopathy, CMR: cardiac magnetic resonance.

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