2.Concordant and Discordant Cardiac Magnetic Resonance Imaging Delayed Hyperenhancement Patterns in Patients with Ischemic and Non-Ischemic Cardiomyopathy.
Eun Kyoung KIM ; Sung A CHANG ; Jin Oh CHOI ; James GLOCKNER ; Brian SHAPIRO ; Yeon Hyeon CHOE ; Nowell FINE ; Shin Yi JANG ; Sung Mok KIM ; Wayne MILLER ; Sang Chol LEE ; Jae K OH
Korean Circulation Journal 2016;46(1):41-47
BACKGROUND AND OBJECTIVES: The diagnosis of ischemic (ICM) and non-ischemic cardiomyopathy (NICM) is conventionally determined by the presence or absence of coronary artery disease (CAD) in the setting of a reduced left systolic function. However the presence of CAD may not always indicate that the actual left ventricular (LV) dysfunction mechanism is ischemia, as other non-ischemic etiologies can be responsible. We investigated patterns of myocardial fibrosis using delayed hyperenhancement (DHE) on cardiac magnetic resonance (CMR) in ICM and NICM. SUBJECTS AND METHODS: Patients with systolic heart failure who underwent a CMR were prospectively analyzed. The heart failure diagnosis was based on the modified Framingham criteria and LVEF <35%. LV dysfunction was classified as ICM or NICM based on coronary anatomy. RESULTS: A total of 101 subjects were analyzed; 34 were classified as ICM and 67 as NICM. The DHE pattern was concordant with the conventional diagnosis in 27 (79.4%) of the patients with ICM and 62 (92.5%) of the patients with NCIM. A discordant NICM DHE pattern was present in 8.8% of patients with ICM, and an ICM pattern was detected 6.0% of the patients with NICM. Furthermore, 11.8% of the patients with ICM and 1.5% of those with NICM demonstrated a mixed pattern. CONCLUSION: A subset of patients conventionally diagnosed with ICM or NICM based on coronary anatomy demonstrated a discordant or mixed DHE pattern. CMR-DHE imaging can be helpful to determine the etiology of heart failure in patients with persistent LV systolic dysfunction.
Cardiac Imaging Techniques
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Cardiomyopathies*
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Coronary Artery Disease
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Diagnosis
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Fibrosis
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Heart Failure
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Heart Failure, Systolic
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Humans
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Ischemia
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Magnetic Resonance Imaging*
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Prospective Studies