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Intra-cardiac distribution of late gadolinium enhancement in cardiac sarcoidosis and dilated cardiomyopathy

View Article: PubMed Central - PubMed

ABSTRACT

Cardiac involvement of sarcoid lesions is diagnosed by myocardial biopsy which is frequently false-negative, and patients with cardiac sarcoidosis (CS) who have impaired left ventricular (LV) systolic function are sometimes diagnosed with dilated cardiomyopathy (DCM). Late gadolinium enhancement (LE) in magnetic resonance imaging is now a critical finding in diagnosing CS, and the novel Japanese guideline considers myocardial LE to be a major criterion of CS. This article describes the value of LE in patients with CS who have impaired LV systolic function, particularly the diagnostic and clinical significance of LE distribution in comparison with DCM. LE existed at all LV segments and myocardial layers in patients with CS, whereas it was localized predominantly in the midwall of basal to mid septum in those with DCM. Transmural (nodular), circumferential, and subepicardial and subendocardial LE distribution were highly specific in patients with CS, whereas the prevalence of striated midwall LE were high both in patients with CS and with DCM. Since sarcoidosis patients with LE have higher incidences of heart failure symptoms, ventricular tachyarrhythmia and sudden cardiac death, the analyses of extent and distribution of LE are crucial in early diagnosis and therapeutic approach for patients with CS.

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Intra-left ventricles (A) and intra-mural (B) late gadolinium enhancement distribution in patients with cardiac sarcoidosis and with dilated cardiomyopathy. A: Columns indicate prevalence of LE at each LV segment in patients with CS (black) and with DCM (gray). A: Anterior; aL: Antero-lateral; aS: Anterior septal; I: Inferior; iL: Infero-lateral wall in basal, mid and apical LV; AP: LV apex; B: Columns consist of prevalence of LE with scores 1 to 3 at different intra-mural distribution in patients with CS and with DCM. Score 4 indicates the transmural distribution. CS: Cardiac sarcoidosis; DCM: Dilated cardiomyopathy; LV: Left ventricles.
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Figure 2: Intra-left ventricles (A) and intra-mural (B) late gadolinium enhancement distribution in patients with cardiac sarcoidosis and with dilated cardiomyopathy. A: Columns indicate prevalence of LE at each LV segment in patients with CS (black) and with DCM (gray). A: Anterior; aL: Antero-lateral; aS: Anterior septal; I: Inferior; iL: Infero-lateral wall in basal, mid and apical LV; AP: LV apex; B: Columns consist of prevalence of LE with scores 1 to 3 at different intra-mural distribution in patients with CS and with DCM. Score 4 indicates the transmural distribution. CS: Cardiac sarcoidosis; DCM: Dilated cardiomyopathy; LV: Left ventricles.

Mentions: The intra-LV LE distribution was analyzed using the 17-segments model[16]. Next, we visually divided the intra-mural LE distribution into subepicardial, midwall and subendocardial distribution. Then, the extent of LE in each segment was determined with a five-point scoring system (0 = no LE, 1 = 1%-25%, 2 = 26%-50%, 3 = 51%-75%, 4 = 76%-100% of transmural extent of LE). The segment with score 4 was defined as “transmural” distribution[16]. LE in patients with CS existed predominantly in the basal and mid septum, but also distributed throughout LV segments. While in patients with DCM, LE was localized mostly in the basal and mid septum[13,16]. In addition, LE distributed across all the myocardial layers in patients with CS, but was predominantly localized at the midwall in those with DCM (Figure 2). The averaged LE score in each LV segment was significantly higher in CS than that in DCM [0.95 ± 0.67 vs 0.42 ± 0.43, mean ± standard deviation (SD), P < 0.05].


Intra-cardiac distribution of late gadolinium enhancement in cardiac sarcoidosis and dilated cardiomyopathy
Intra-left ventricles (A) and intra-mural (B) late gadolinium enhancement distribution in patients with cardiac sarcoidosis and with dilated cardiomyopathy. A: Columns indicate prevalence of LE at each LV segment in patients with CS (black) and with DCM (gray). A: Anterior; aL: Antero-lateral; aS: Anterior septal; I: Inferior; iL: Infero-lateral wall in basal, mid and apical LV; AP: LV apex; B: Columns consist of prevalence of LE with scores 1 to 3 at different intra-mural distribution in patients with CS and with DCM. Score 4 indicates the transmural distribution. CS: Cardiac sarcoidosis; DCM: Dilated cardiomyopathy; LV: Left ventricles.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037324&req=5

Figure 2: Intra-left ventricles (A) and intra-mural (B) late gadolinium enhancement distribution in patients with cardiac sarcoidosis and with dilated cardiomyopathy. A: Columns indicate prevalence of LE at each LV segment in patients with CS (black) and with DCM (gray). A: Anterior; aL: Antero-lateral; aS: Anterior septal; I: Inferior; iL: Infero-lateral wall in basal, mid and apical LV; AP: LV apex; B: Columns consist of prevalence of LE with scores 1 to 3 at different intra-mural distribution in patients with CS and with DCM. Score 4 indicates the transmural distribution. CS: Cardiac sarcoidosis; DCM: Dilated cardiomyopathy; LV: Left ventricles.
Mentions: The intra-LV LE distribution was analyzed using the 17-segments model[16]. Next, we visually divided the intra-mural LE distribution into subepicardial, midwall and subendocardial distribution. Then, the extent of LE in each segment was determined with a five-point scoring system (0 = no LE, 1 = 1%-25%, 2 = 26%-50%, 3 = 51%-75%, 4 = 76%-100% of transmural extent of LE). The segment with score 4 was defined as “transmural” distribution[16]. LE in patients with CS existed predominantly in the basal and mid septum, but also distributed throughout LV segments. While in patients with DCM, LE was localized mostly in the basal and mid septum[13,16]. In addition, LE distributed across all the myocardial layers in patients with CS, but was predominantly localized at the midwall in those with DCM (Figure 2). The averaged LE score in each LV segment was significantly higher in CS than that in DCM [0.95 ± 0.67 vs 0.42 ± 0.43, mean ± standard deviation (SD), P < 0.05].

View Article: PubMed Central - PubMed

ABSTRACT

Cardiac involvement of sarcoid lesions is diagnosed by myocardial biopsy which is frequently false-negative, and patients with cardiac sarcoidosis (CS) who have impaired left ventricular (LV) systolic function are sometimes diagnosed with dilated cardiomyopathy (DCM). Late gadolinium enhancement (LE) in magnetic resonance imaging is now a critical finding in diagnosing CS, and the novel Japanese guideline considers myocardial LE to be a major criterion of CS. This article describes the value of LE in patients with CS who have impaired LV systolic function, particularly the diagnostic and clinical significance of LE distribution in comparison with DCM. LE existed at all LV segments and myocardial layers in patients with CS, whereas it was localized predominantly in the midwall of basal to mid septum in those with DCM. Transmural (nodular), circumferential, and subepicardial and subendocardial LE distribution were highly specific in patients with CS, whereas the prevalence of striated midwall LE were high both in patients with CS and with DCM. Since sarcoidosis patients with LE have higher incidences of heart failure symptoms, ventricular tachyarrhythmia and sudden cardiac death, the analyses of extent and distribution of LE are crucial in early diagnosis and therapeutic approach for patients with CS.

No MeSH data available.


Related in: MedlinePlus