Limits...
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.

No MeSH data available.


Related in: MedlinePlus

Typical late gadolinium enhancement distribution profiles. Characteristic patterns of LE distribution in LE-MRI (A) and the cartoons (B). Striated: Striated LE distribution in midwall; Nodular: Nodular (transmural) LE distribution; Circumferential: Subepicardial LE distribution in > 50% circumferential LV wall; Sub-epi + sub-end: Subepicardial and subendocardial LE distribution with spared midwall (white arrows); C: The prevalence of characteristic patterns of LE distribution in patients with CS and with DCM. CS: Cardiac sarcoidosis; DCM: Dilated cardiomyopathy; LE: Late gadolinium enhancement; LV/RV: Left and right ventricles; MRI: Magnetic resonance imaging.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5037324&req=5

Figure 3: Typical late gadolinium enhancement distribution profiles. Characteristic patterns of LE distribution in LE-MRI (A) and the cartoons (B). Striated: Striated LE distribution in midwall; Nodular: Nodular (transmural) LE distribution; Circumferential: Subepicardial LE distribution in > 50% circumferential LV wall; Sub-epi + sub-end: Subepicardial and subendocardial LE distribution with spared midwall (white arrows); C: The prevalence of characteristic patterns of LE distribution in patients with CS and with DCM. CS: Cardiac sarcoidosis; DCM: Dilated cardiomyopathy; LE: Late gadolinium enhancement; LV/RV: Left and right ventricles; MRI: Magnetic resonance imaging.

Mentions: Previous reports have also shown that transmural (nodular) distribution, circumferential subepicardial distribution, and subepicardial and subendocardial distribution (with spared midwall) are highly characteristic in CS, whereas striated distribution in midwall is typical in DCM (Figure 3A)[5,10]. In our analysis, transmural (nodular), circumferential, and subepicardial and subendocardial LE distribution were highly specific in patients with CS, although the prevalence of those distribution patterns was low. In contrast, the prevalence of striated midwall LE distribution was high in both groups, but the specificity was low (Figure 3B and Table 3).


Intra-cardiac distribution of late gadolinium enhancement in cardiac sarcoidosis and dilated cardiomyopathy
Typical late gadolinium enhancement distribution profiles. Characteristic patterns of LE distribution in LE-MRI (A) and the cartoons (B). Striated: Striated LE distribution in midwall; Nodular: Nodular (transmural) LE distribution; Circumferential: Subepicardial LE distribution in > 50% circumferential LV wall; Sub-epi + sub-end: Subepicardial and subendocardial LE distribution with spared midwall (white arrows); C: The prevalence of characteristic patterns of LE distribution in patients with CS and with DCM. CS: Cardiac sarcoidosis; DCM: Dilated cardiomyopathy; LE: Late gadolinium enhancement; LV/RV: Left and right ventricles; MRI: Magnetic resonance imaging.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Typical late gadolinium enhancement distribution profiles. Characteristic patterns of LE distribution in LE-MRI (A) and the cartoons (B). Striated: Striated LE distribution in midwall; Nodular: Nodular (transmural) LE distribution; Circumferential: Subepicardial LE distribution in > 50% circumferential LV wall; Sub-epi + sub-end: Subepicardial and subendocardial LE distribution with spared midwall (white arrows); C: The prevalence of characteristic patterns of LE distribution in patients with CS and with DCM. CS: Cardiac sarcoidosis; DCM: Dilated cardiomyopathy; LE: Late gadolinium enhancement; LV/RV: Left and right ventricles; MRI: Magnetic resonance imaging.
Mentions: Previous reports have also shown that transmural (nodular) distribution, circumferential subepicardial distribution, and subepicardial and subendocardial distribution (with spared midwall) are highly characteristic in CS, whereas striated distribution in midwall is typical in DCM (Figure 3A)[5,10]. In our analysis, transmural (nodular), circumferential, and subepicardial and subendocardial LE distribution were highly specific in patients with CS, although the prevalence of those distribution patterns was low. In contrast, the prevalence of striated midwall LE distribution was high in both groups, but the specificity was low (Figure 3B and Table 3).

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