Late gadolinium enhancement (LGE) has an established prognostic value in otherwise normal hearts, when detected with a subepicardial or intramyocardial pattern; nevertheless, the clinical relevance of isolated right ventricular insertion point (RVIP) LGE is yet to be defined. From a retrospectively identified cohort of 2000 consecutive patients undergoing CMR, we selected 420 patients according to study’s inclusion and exclusion criteria (270 males, mean age 38 ± 17 years) with apparently normal hearts: besides 36 patients with non-ischemic pattern LGE (other-LGE group), we found isolated RVIP-LGE in 44 patients and absence of LGE (no-LGE group) in 340 patients. Clinical follow-up was performed for a median of approximately 6 years. Primary composite endpoint included cardiac death, resuscitated cardiac arrest, and appropriate implantable cardiac defibrillator shock. Prevalence of cardiac events was significantly lower in RVIP-LGE than in the other-LGE group (p = 0.006). Kaplan Meier curve analysis demonstrated no significant differences between patients with RVIP-LGE and no-LGE for the primary endpoint. On contrast, patients with other-LGE had worse prognosis than those with RVIP-LGE or no-LGE (p < 0.0001). RVIP-LGE in subjects without additional evidence of cardiac damage does not convey worse prognosis when compared to subjects without LGE and it should not be considered a marker of disease. Its diagnostic and prognostic significance is to be considered irrelevant.
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Grigoratos, C., Pantano, A., Meschisi, M. et al. Clinical importance of late gadolinium enhancement at right ventricular insertion points in otherwise normal hearts. Int J Cardiovasc Imaging (2020). https://doi.org/10.1007/s10554-020-01783-y
- Magnetic resonance imaging
- Right ventricular insertion points
- Late gadolinium enhancement
- Junctional fibrosis