Distribution of late gadolinium enhancement in end-stage hypertrophic cardiomyopathy and dilated cardiomyopathy: Differential diagnosis and prediction of cardiac outcome |
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Authors: | Masashi Machii Hiroshi Satoh Katsunori Shiraki Masao Saotome Tsuyoshi Urushida Hideki Katoh Yasuo Takehara Harumi Sakahara Hayato Ohtani Yasushi Wakabayashi Hiroshi Ukigai Kei Tawarahara Hideharu Hayashi |
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Affiliation: | 1. Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan;2. Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan;3. Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Japan;4. Department of Cardiology, Hamamatsu Red Cross Hospital, Hamamatsu, Japan |
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Abstract: | BackgroundThe prognostic implications of late gadolinium enhancement (LGE) have been evaluated in ischemic and non-ischemic cardiomyopathies. The present study analyzed LGE distribution in patients with end-stage hypertrophic cardiomyopathy (ES-HCM) and with dilated cardiomyopathy (DCM), and tried to identify high risk patients in DCM.MethodsEleven patients with ES-HCM and 72 with DCM underwent cine- and LGE-cardiac magnetic resonance and ultrasound cardiography. The patient outcome was analyzed retrospectively for 5 years of follow-up.ResultsLGE distributed mainly in the inter-ventricular septum, but spread more diffusely into other left ventricular segments in patients with ES-HCM and in a certain part of patients with DCM. Thus, patients with DCM can be divided into three groups according to LGE distribution; no LGE (n = 24), localized LGE (localized at septum, n = 36), and extensive LGE (spread into other segments, n = 12). Reverse remodeling occurred after treatment in patients with no LGE and with localized LGE, but did not in patients with extensive LGE and with ES-HCM. The event-free survival rate for composite outcome (cardiac death, hospitalization for decompensated heart failure or ventricular arrhythmias) was lowest in patients with extensive LGE (92%, 74% and 42% in no LGE, localized LGE, and extensive LGE, p = 0.02 vs. no LGE), and was comparable to that in patients with ES-HCM (42%).ConclusionsIn DCM, patients with extensive LGE showed no functional recovery and the lowest event-free survival rate that were comparable to patients with ES-HCM. The analysis of LGE distribution may be valuable to predict reverse remodeling and to identify high-risk patients. |
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Keywords: | Dilated cardiomyopathy End-stage hypertrophic cardiomyopathy Late gadolinium enhancement Cardiac magnetic resonance Reverse remodeling Outcomes |
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