Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Concordant and Discordant Cardiac Magnetic Resonance Imaging Delayed Hyperenhancement Patterns in Patients with Ischemic and Non-Ischemic Cardiomyopathy

  • Kim, Eun Kyoung (Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chang, Sung-A (Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Jin-Oh (Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Glockner, James (Division of Cardiovascular Diseases, Mayo Clinic College of Medicine) ;
  • Shapiro, Brian (Division of Cardiovascular Diseases, Mayo Clinic College of Medicine) ;
  • Choe, Yeon Hyeon (Department of Radiology, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Fine, Nowell (Division of Cardiovascular Diseases, Mayo Clinic College of Medicine) ;
  • Jang, Shin Yi (Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Sung-Mok (Department of Radiology, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Miller, Wayne (Division of Cardiovascular Diseases, Mayo Clinic College of Medicine) ;
  • Lee, Sang-Chol (Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Oh, Jae K. (Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2015.03.10
  • Accepted : 2015.07.14
  • Published : 2016.01.30
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Abstract

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.

Keywords

Acknowledgement

Supported by : Samsung Medical Center

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