Abstract
Recent advances in cardiovascular magnetic resonance have made it an important clinical tool. Late gadolinium enhancement imaging after gadolinium administration is now a well-validated and practical test to assess myocardial scarring. Due to its high spatial resolution, late gadolinium enhancement is much more sensitive in detecting small infarctions than older imaging modalities. However, late gadolinium enhancement is not specific for myocardial infarction but can occur in a number of cardiomyopathies. New studies suggest that the extent and pattern of enhancement may have prognostic and therapeutic implications, making it an important non-invasive instrument in cardiovascular diagnostics.
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Risk stratification and survival after myocardial infarction [no authors listed]. N Engl J Med 1983, 309:331–336.
Steen H, Giannitsis E, Futterer S, et al.: Cardiac troponin T at 96 hours after acute myocardial infarction correlates with infarct size and cardiac function. J Am Coll Cardiol 2006, 48:2192–2194.
Wagner A, Mahrholdt H, Holly TA, et al.: Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet 2003, 361:374–379.
Assomull RG, Prasad SK, Lyne J, et al.: Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol 2006, 48:1977–1985.
Moon JC, McKenna WJ, McCrohon JA, et al.: Toward clinical risk assessment in hypertrophic cardiomyopathy with gadolinium cardiovascular magnetic resonance. J Am Coll Cardiol 2003, 41:1561–1567.
Kwong RY, Chan AK, Brown KA, et al.: Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation 2006, 113:2733–2743.
Allman KC, Shaw LJ, Hachamovitch R, et al.: Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol 2002, 39:1151–1158.
Hombach V, Grebe O, Merkle N, et al.: Sequelae of acute myocardial infarction regarding cardiac structure and function and their prognostic significance as assessed by magnetic resonance imaging. Eur Heart J 2005, 26:549–557.
Wu KC, Zerhouni EA, Judd RM, et al.: Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 1998, 97:765–772.
Bleeker GB, Kaandorp TA, Lamb HJ, et al.: Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation 2006, 113:969–976.
White JA, Yee R, Yuan X, et al.: Delayed enhancement magnetic resonance imaging predicts response to cardiac resynchronization therapy in patients with intraventricular dyssynchrony. J Am Coll Cardiol 2006, 48:1953–1960.
Simonetti OP, Kim RJ, Fieno DS, et al.: An improved MR imaging technique for the visualization of myocardial infarction. Radiology 2001, 218:215–223.
Kellman P, Arai AE, McVeigh ER, et al.: Phase-sensitive inversion recovery for detecting myocardial infarction using gadolinium-delayed hyperenhancement. Magn Reson Med 2002, 47:372–383.
Selvanayagam JB, Porto I, Channon K, et al.: Troponin elevation after percutaneous coronary intervention directly represents the extent of irreversible myocardial injury: insights from cardiovascular magnetic resonance imaging. Circulation 2005, 111:1027–1032.
Sievers B, Elliott MD, Hurwitz LM, et al.: Rapid detection of myocardial infarction by subsecond, free-breathing delayed contrast-enhancement cardiovascular magnetic resonance. Circulation 2007, 115:236–244.
Gersh BJ, Anderson JL: Thrombolysis and myocardial salvage. Results of clinical trials and the animal paradigm—paradoxic or predictable? Circulation 1993, 88:296–306.
Ragosta M, Camarano G, Kaul S, et al.: Microvascular integrity indicates myocellular viability in patients with recent myocardial infarction. New insights using myocardial contrast echocardiography. Circulation 1994, 89:2562–2569.
Rogers WJ Jr, Kramer CM, Geskin G, et al.: Early contrast-enhanced MRI predicts late functional recovery after reperfused myocardial infarction. Circulation 1999, 99:744–750.
Choi CJ, Haji-Momenian S, DiMaria JM, et al.: Infarct involution and improved function during healing of acute myocardial infarction: the role of microvascular obstruction. J Cardiovasc Magn Reson 2004, 6:917–925.
Ibrahim T, Bulow HP, Hackl T, et al.: Diagnostic value of contrast-enhanced magnetic resonance imaging and single-photon emission computed tomography for detection of myocardial necrosis early after acute myocardial infarction. J Am Coll Cardiol 2007, 49:208–216.
Sheifer SE, Manolio TA, Gersh BJ: Unrecognized myocardial infarction. Ann Intern Med 2001, 135:801–811.
Barbier CE, Bjerner T, Johansson L, et al.: Myocardial scars more frequent than expected: magnetic resonance imaging detects potential risk group. J Am Coll Cardiol 2006, 48:765–771.
Kim RJ, Wu E, Rafael A, et al.: The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 2000, 343:1445–1453.
Selvanayagam JB, Kardos A, Francis JM, et al.: Value of delayed-enhancement cardiovascular magnetic resonance imaging in predicting myocardial viability after surgical revascularization. Circulation 2004, 110:1535–1541.
Wellnhofer E, Bocksch W, Hiemann N, et al.: Shear stress and vascular remodeling: study of cardiac allograft coronary artery disease as a model of diffuse atherosclerosis. J Heart Lung Transplant 2002, 21:405–416.
Bove CM, DiMaria JM, Voros S, et al.: Dobutamine response and myocardial infarct transmurality: functional improvement after coronary artery bypass grafting—initial experience. Radiology 2006, 240:835–841.
Gutberlet M, Frohlich M, Mehl S, et al.: Myocardial viability assessment in patients with highly impaired left ventricular function: comparison of delayed enhancement, dobutamine stress MRI, end-diastolic wall thickness, and TI201-SPECT with functional recovery after revascularization. Eur Radiol 2005, 15:872–880.
Klem I, Heitner JF, Shah DJ, et al.: Improved detection of coronary artery disease by stress perfusion cardiovascular magnetic resonance with the use of delayed enhancement infarction imaging. J Am Coll Cardiol 2006, 47:1630–1638.
Ingkanisorn WP, Kwong RY, Bohme NS, et al.: Prognosis of negative adenosine stress magnetic resonance in patients presenting to an emergency department with chest pain. J Am Coll Cardiol 2006, 47:1427–1432.
McCrohon JA, Moon JC, Prasad SK, et al.: Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation 2003, 108:54–59.
Soriano CJ, Ridocci F, Estornell J, et al.: Noninvasive diagnosis of coronary artery disease in patients with heart failure and systolic dysfunction of uncertain etiology, using late gadolinium-enhanced cardiovascular magnetic resonance. J Am Coll Cardiol 2005, 45:743–748.
Schietinger BJ, Voros S, Isbell DC, et al.: Can late gadolinium enhancement by cardiovascular magnetic resonance identify coronary artery disease as the etiology of new onset congestive heart failure? Int J Cardiovasc Imaging 2007, 23:595–602.
Felker GM, Hu W, Hare JM, et al.: The spectrum of dilated cardiomyopathy. The Johns Hopkins experience with 1,278 patients. Medicine (Baltimore) 1999, 78:270–283.
Doolan A, Langlois N, Semsarian C: Causes of sudden cardiac death in young Australians. Med J Aust 2004, 180:110–112.
Fuster V, Gersh BJ, Giuliani ER, et al.: The natural history of idiopathic dilated cardiomyopathy. Am J Cardiol 1981, 47:525–531.
Kawai C: From myocarditis to cardiomyopathy: mechanisms of inflammation and cell death: learning from the past for the future. Circulation 1999, 99:1091–1100.
Mahrholdt H, Goedecke C, Wagner A, et al.: Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 2004, 109:1250–1258.
Mahrholdt H, Wagner A, Deluigi CC, et al.: Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation 2006, 114:1581–1590.
Wagner A, Schulz-Menger J, Dietz R, et al.: Long-term follow-up of patients with acute myocarditis by magnetic resonance imaging. MAGMA 2003, 16:17–20.
Rickers C, Wilke NM, Jerosch-Herold M, et al.: Utility of cardiac magnetic resonance imaging in the diagnosis of hypertrophic cardiomyopathy. Circulation 2005, 112:855–861.
Moon JC, Reed E, Sheppard MN, et al.: The histologic basis of late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Am Coll Cardiol 2004, 43:2260–2264.
Harris KM, Spirito P, Maron MS, et al.: Prevalence, clinical profile, and significance of left ventricular remodeling in the end-stage phase of hypertrophic cardiomyopathy. Circulation 2006, 114:216–225.
Smedema JP, Snoep G, van Kroonenburgh MP, et al.: Evaluation of the accuracy of gadolinium-enhanced cardiovascular magnetic resonance in the diagnosis of cardiac sarcoidosis. J Am Coll Cardiol 2005, 45:1683–1690.
Stauder NI, Bader B, Fenchel M, et al.: Images in cardiovascular medicine. Follow-up of cardiac sarcoidosis by magnetic resonance imaging. Circulation 2005, 111:e158–e160.
Maceira AM, Joshi J, Prasad SK, et al.: Cardiovascular magnetic resonance in cardiac amyloidosis. Circulation 2005, 111:186–193.
Tandri H, Saranathan M, Rodriguez ER, et al.: Noninvasive detection of myocardial fibrosis in arrhythmogenic right ventricular cardiomyopathy using delayed-enhancement magnetic resonance imaging. J Am Coll Cardiol 2005, 45:98–103.
Sen-Chowdhry S, Syrris P, Ward D, et al.: Clinical and genetic characterization of families with arrhythmogenic right ventricular dysplasia/cardiomyopathy provides novel insights into patterns of disease expression. Circulation 2007, 115:1710–1720.
Babu-Narayan SV, Kilner PJ, Li W, et al.: Ventricular fibrosis suggested by cardiovascular magnetic resonance in adults with repaired tetralogy of Fallot and its relationship to adverse markers of clinical outcome. Circulation 2006, 113:405–413.
Blyth KG, Groenning BA, Martin TN, et al.: Contrast enhanced-cardiovascular magnetic resonance imaging in patients with pulmonary hypertension. Eur Heart J 2005, 26:1993–1999.
Abraham WT, Fisher WG, Smith AL, et al.: Cardiac resynchronization in chronic heart failure. N Engl J Med 2002, 346:1845–1853.
Bristow MR, Saxon LA, Boehmer J, et al.: Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004, 350:2140–2150.
Cazeau S, Leclercq C, Lavergne T, et al.: Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001, 344:873–880.
Cleland JG, Daubert JC, Erdmann E, et al.: The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005, 352:1539–1549.
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Lin, D., Kramer, C.M. Late gadolinium-enhanced cardiac magnetic resonance. Curr Cardiol Rep 10, 72–78 (2008). https://doi.org/10.1007/s11886-008-0014-4
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DOI: https://doi.org/10.1007/s11886-008-0014-4