Late gadolinium enhancement in the whole heart demonstrated 100% sensitivity for predicting microscopic myocardial scarring and independently correlated with the collagen fraction (β=0.59) in HCM.
Observational (n=21)
Blinded analysis
No
Does cardiac magnetic resonance imaging with late gadolinium enhancement predict microscopic myocardial scarring in patients with hypertrophic cardiomyopathy?
LGE-CMR has excellent sensitivity for detecting microscopic myocardial scarring in HCM, and its extent correlates with the quantitative collagen fraction, suggesting it can noninvasively predict myocardial scarring.
Effect estimate: β 0.59 (95% CI 0.15-1.0)
p-value: p=0.012
Background: Myocardial scarring can be assessed by cardiac magnetic resonance imaging with late gadolinium enhancement and by endomyocardial biopsy. However, accuracy of late gadolinium enhancement for predicting microscopic myocardial scarring in biopsied specimens remains unknown in hypertrophic cardiomyopathy. We investigated whether late gadolinium enhancement in the whole heart reflects microscopic myocardial scarring in the small biopsied specimens in hypertrophic cardiomyopathy. Methods and Results: Twenty-one consecutive patients with hypertrophic cardiomyopathy who were examined both by cardiac magnetic resonance imaging and by endomyocardial biopsy were retrospectively studied. The right interventricular septum was the target site for endomyocardial biopsy in all patients. Late gadolinium enhancement in the ventricular septum had an excellent sensitivity (100%) with a low specificity (40%) for predicting microscopic myocardial scarring in biopsied specimens. The sensitivity of late gadolinium enhancement in the whole heart remained 100% with a specificity of 27% for predicting microscopic myocardial scarring in biopsied specimens. Quantitative assessments of fibrosis revealed that the extent of late gadolinium enhancement in the whole heart was the only independent variable related to the microscopic collagen fraction in biopsied specimens (β = 0.59, 95% confident interval: 0.15-1.0, p = 0.012). Conclusions: Although there was a compromise in the specificity, the sensitivity of late gadolinium enhancement was excellent for prediction of microscopic myocardial scarring in hypertrophic cardiomyopathy. Moreover, the severity of late gadolinium enhancement was independently associated with the quantitative collagen fraction in biopsied specimens in hypertrophic cardiomyopathy. These findings indicate that late gadolinium enhancement can reflect both the presence and the extent of microscopic myocardial scarring in the small biopsied specimens in hypertrophic cardiomyopathy. © 2014 Konno et al.
今野 et al. (2014) conducted an observational in Hypertrophic cardiomyopathy (n=21). Late gadolinium enhancement cardiac magnetic resonance imaging vs. Endomyocardial biopsy was evaluated on Microscopic collagen fraction in biopsied specimens (β 0.59, 95% CI 0.15-1.0, p=0.012). Late gadolinium enhancement in the whole heart demonstrated 100% sensitivity for predicting microscopic myocardial scarring and independently correlated with the collagen fraction (β=0.59) in HCM.