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Cardiac Magnetic Resonance Scar Imaging for Sudden Cardiac Death Risk Stratification in Patients with Non-Ischemic Cardiomyopathy.

Kim EK, Chattranukulchai P, Klem I - Korean J Radiol (2015)

Bottom Line: In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging.We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM.In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

ABSTRACT
In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging. We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM. From the 15 studies analyzed, with a total of 2747 patients, the average prevalence of myocardial scar was 41%. In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar. Based on the available observational, single center studies, CMR scar assessment may be a promising new tool for SCD risk stratification, which merits further investigation.

No MeSH data available.


Related in: MedlinePlus

Different delayed enhancement patterns in non-ischemic cardiomyopathy.Patient 1. 48-year-old female with history of dilated cardiomyopathy. Delayed enhancement images demonstrate intramural contrast enhancement in septum (midwall striae, arrowheads). A. Mid-ventricular short-axis view. B. 4-chamber-view. Patient 2. 50-year-old male with remote history of biopsy-proven viral myocarditis presented with left ventricular dysfunction. Delayed enhancement images demonstrate epicardial hyperenhancement localized at basal inferolateral wall (arrowheads). C. Basal-short axis view. D. 3-chamber-view. Patient 3. 68-year-old male presented with progressive left ventricular dysfunction found to have insignificant coronary stenosis (25% middle left anterior descending artery lesion) on invasive coronary angiography. Delayed enhancement images demonstrate subendocardial hyperenhancement with 75% transmurality (arrowheads) involving inferior and inferolateral walls from middle ventricular level extending through apex consistent with ischemic injury. E. Mid-ventricular short axis view. F. 3-chamber-view.
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Figure 1: Different delayed enhancement patterns in non-ischemic cardiomyopathy.Patient 1. 48-year-old female with history of dilated cardiomyopathy. Delayed enhancement images demonstrate intramural contrast enhancement in septum (midwall striae, arrowheads). A. Mid-ventricular short-axis view. B. 4-chamber-view. Patient 2. 50-year-old male with remote history of biopsy-proven viral myocarditis presented with left ventricular dysfunction. Delayed enhancement images demonstrate epicardial hyperenhancement localized at basal inferolateral wall (arrowheads). C. Basal-short axis view. D. 3-chamber-view. Patient 3. 68-year-old male presented with progressive left ventricular dysfunction found to have insignificant coronary stenosis (25% middle left anterior descending artery lesion) on invasive coronary angiography. Delayed enhancement images demonstrate subendocardial hyperenhancement with 75% transmurality (arrowheads) involving inferior and inferolateral walls from middle ventricular level extending through apex consistent with ischemic injury. E. Mid-ventricular short axis view. F. 3-chamber-view.

Mentions: In this context, it is interesting that myocardial scar can be seen in the basal septum located in the term should be mid-myocardium ("midwall fibrosis" or "midwall striae") in about 30% of patients with NICM (1923); this non-ischemic type of fibrosis can be visualized with post-contrast DE-CMR imaging. Non-ischemic scar in NICM can also be found in epicardial location, or in a patchy pattern of fibrosis, which typically spares the endocardium (Fig. 1). Features of ischemic injury are the involvement of the endocardium, and location in a region consistent with a coronary perfusion territory. This type of endocardial scar from ischemic injury can also be found in NICM without the presence of significant epicardial coronary disease, and can result from embolic events, coronary vasospasm, or spontaneously recanalized plaque rupture with insignificant stenosis (24). The pattern and localization of myocardial fibrosis seen on DE-CMR can help identify the etiology of cardiomyopathy and is frequently used in the work-up of patients with new diagnosis of reduced LVEF or congestive heart failure symptoms (25).


Cardiac Magnetic Resonance Scar Imaging for Sudden Cardiac Death Risk Stratification in Patients with Non-Ischemic Cardiomyopathy.

Kim EK, Chattranukulchai P, Klem I - Korean J Radiol (2015)

Different delayed enhancement patterns in non-ischemic cardiomyopathy.Patient 1. 48-year-old female with history of dilated cardiomyopathy. Delayed enhancement images demonstrate intramural contrast enhancement in septum (midwall striae, arrowheads). A. Mid-ventricular short-axis view. B. 4-chamber-view. Patient 2. 50-year-old male with remote history of biopsy-proven viral myocarditis presented with left ventricular dysfunction. Delayed enhancement images demonstrate epicardial hyperenhancement localized at basal inferolateral wall (arrowheads). C. Basal-short axis view. D. 3-chamber-view. Patient 3. 68-year-old male presented with progressive left ventricular dysfunction found to have insignificant coronary stenosis (25% middle left anterior descending artery lesion) on invasive coronary angiography. Delayed enhancement images demonstrate subendocardial hyperenhancement with 75% transmurality (arrowheads) involving inferior and inferolateral walls from middle ventricular level extending through apex consistent with ischemic injury. E. Mid-ventricular short axis view. F. 3-chamber-view.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499533&req=5

Figure 1: Different delayed enhancement patterns in non-ischemic cardiomyopathy.Patient 1. 48-year-old female with history of dilated cardiomyopathy. Delayed enhancement images demonstrate intramural contrast enhancement in septum (midwall striae, arrowheads). A. Mid-ventricular short-axis view. B. 4-chamber-view. Patient 2. 50-year-old male with remote history of biopsy-proven viral myocarditis presented with left ventricular dysfunction. Delayed enhancement images demonstrate epicardial hyperenhancement localized at basal inferolateral wall (arrowheads). C. Basal-short axis view. D. 3-chamber-view. Patient 3. 68-year-old male presented with progressive left ventricular dysfunction found to have insignificant coronary stenosis (25% middle left anterior descending artery lesion) on invasive coronary angiography. Delayed enhancement images demonstrate subendocardial hyperenhancement with 75% transmurality (arrowheads) involving inferior and inferolateral walls from middle ventricular level extending through apex consistent with ischemic injury. E. Mid-ventricular short axis view. F. 3-chamber-view.
Mentions: In this context, it is interesting that myocardial scar can be seen in the basal septum located in the term should be mid-myocardium ("midwall fibrosis" or "midwall striae") in about 30% of patients with NICM (1923); this non-ischemic type of fibrosis can be visualized with post-contrast DE-CMR imaging. Non-ischemic scar in NICM can also be found in epicardial location, or in a patchy pattern of fibrosis, which typically spares the endocardium (Fig. 1). Features of ischemic injury are the involvement of the endocardium, and location in a region consistent with a coronary perfusion territory. This type of endocardial scar from ischemic injury can also be found in NICM without the presence of significant epicardial coronary disease, and can result from embolic events, coronary vasospasm, or spontaneously recanalized plaque rupture with insignificant stenosis (24). The pattern and localization of myocardial fibrosis seen on DE-CMR can help identify the etiology of cardiomyopathy and is frequently used in the work-up of patients with new diagnosis of reduced LVEF or congestive heart failure symptoms (25).

Bottom Line: In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging.We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM.In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

ABSTRACT
In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging. We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM. From the 15 studies analyzed, with a total of 2747 patients, the average prevalence of myocardial scar was 41%. In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar. Based on the available observational, single center studies, CMR scar assessment may be a promising new tool for SCD risk stratification, which merits further investigation.

No MeSH data available.


Related in: MedlinePlus