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Clinical importance of late gadolinium enhancement at right ventricular insertion points in otherwise normal hearts

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Abstract

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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Funding

This study received no funding.

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Authors and Affiliations

  1. Fondazione Toscana G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy

    Chrysanthos Grigoratos, Andrea Barison, Giancarlo Todiere, Pierluigi Festa & Giovanni Donato Aquaro

  2. Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata of Trieste (ASUITS), Trieste, Italy

    Adriana Pantano & Gianfranco Sinagra

  3. Division of Cardiology, Department of Pathobiology and Biotechnology Medical and Forensic, University of Palermo, Palermo, Italy

    Maria Meschisi

  4. Institute of Cardiology and Center of Excellence on Aging, G. d’Annunzio University, Chieti, Italy

    Raffaella Gaeta

  5. Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Lamia Ait-Ali

Authors
  1. Chrysanthos Grigoratos
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  2. Adriana Pantano
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  3. Maria Meschisi
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  4. Raffaella Gaeta
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  5. Lamia Ait-Ali
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  6. Andrea Barison
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  7. Giancarlo Todiere
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  8. Pierluigi Festa
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  9. Gianfranco Sinagra
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  10. Giovanni Donato Aquaro
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Corresponding author

Correspondence to Chrysanthos Grigoratos.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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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 36, 913–920 (2020). https://doi.org/10.1007/s10554-020-01783-y

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  • DOI: https://doi.org/10.1007/s10554-020-01783-y

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