Impact of cardiac magnetic resonance on the diagnosis and management of patients with cardiomyopathies
Categoria dell'articolo: Original Article
Pubblicato online: 05 set 2024
Pagine: 169 - 178
DOI: https://doi.org/10.2478/rjc-2024-0021
Parole chiave
© 2024 Oana-Andreea Popa et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
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Comparison of CMR’s significant clinical impact in current studies
| Study | Study period | Study patient | n | Change in diagnostic (%) | Change in management (%) |
|---|---|---|---|---|---|
| Bruder O et al. [ |
2007-2009 | euro CMR registry (German pilot) | 11, 040 | 16.4% | 61.8% |
| Bruder O et al. [ |
2006-2012 | SCMR registry | 27,301 | 8.7 % | 61 % |
| Roifman et al. [ |
2013-2019 | Patients with HF indications from the SCMR registry | 3,837 | 49% | - |
| Abbasi et al. [ |
2013 | Patient with LVEF < 50%. | 150 | 52% | 65% |
| Lin et al. [ |
2004-2017 | Patients Undergoing Cardiac Transplantation | 338 | 23 (7%) | |
| Kangala et al. [ |
2017 | Patient with HFpEF | 154 | 27% | |
| Witek et al. [ |
2008-2017 | Patient with HF of unknown etiology | 243 | 38. 7% | 16.9% |
| Onciul et al. [ |
2018-2020 | Patient referred for stress CMR | 120 | 15.85% |
CMR criteria for the majority of cardiomyopathy diagnoses
| Indication | Structural Features (cine-SSFP) | LGE | Native T1 | ECV | T2 |
|---|---|---|---|---|---|
-LV dilatation and disfunction - diffuse regional wall motion abnormalities - +/_RV dilatation and disfunction |
- typical mid-wall pattern | -slightly diffuse increased | -slightly increased | - slightly increased, especially in inflammatory etiologies | |
-no LV dilatation with LV disfunction -normal LV systolic function with + LGE |
-nonischemic pattern | -normal -slightly increased |
-normal -slightly increased |
-can be increased in inflammatory etiologies | |
-none -regional wall motion abnormalities -global LV dysfunction -pericardial effusion |
-patchy subepicardial pattern | -increased in the oedema zone | -increased in the oedema zone | -regional or global increased | |
-hypertrophy (≥15 mm LV wall thickness): symmetrical, asymmetric, apical - other anomalies: LV crypts, papillar hypertrophy, SAM |
-mid-wall, usually in the areas where the wall is the thickest -insertion points of the septum to the RV level |
-increased | -increased | -normal -slightly increased in the burnout type |
|
-RV dilatation, dysfunction, -akinetic, dyskinetic aneurysms at the RV level, often affecting the RV triangle: sub tricuspid area, RV ejection tract, and RV apex -LV systolic dysfunction, regional wall motion abnormality |
- transmural RV region(s) (inlet, outlet, and apex) - subepicardial or mid-wall at LV lateral/inferolateral, septum, or both -subepicardial circumferential infiltration in those with predominantly LV damage |
-decreased in fat infiltration -increased in scar region |
-non-specific | - can be increased at the level of LGE in acute phases | |
-concentric hypertrophy -IAS, LA wall thickening - LV dysfunction -pericardial effusion |
-diffuse subendocardial -nulling effect of the myocardium -dark blood aspect |
-diffuse increased | -very increased | -non-specific pattern - can be increased in those with AL form |
|
-global systolic dysfunction -regional or global wall motion abnormalities, -bi-ventricular dilatation or hypertrophy. -slight increase in left ventricular mass secondary to granulomatous expansion |
-mid-wall or sub-epicardial focal fibrosis, -transmural or subendocardial, but without a correlation to a coronary territory -papillary muscles, RV-free wall, and the atria can also be involved. |
-increased in the scar zone | - increased diffuse | -increased in areas with granulomas | |
-noncompacted-to-compacted myocardium ratio of 2.3:1 -trabeculated mass > 20% - LV disfunction/dilatation |
-non-specific pattern -most frecvent subepicardial |
-slightly increase | -increased diffuse | -normal | |
| -concentric important LV hypertrophy | -mid-wall inferolateral -mid-wall septal |
-decreased - pseudonormal |
-decreased | -slightly increased, basal anteroseptal | |
-normal -LV dysfunction -regional wall motion defects |
-focal fibrosis predominantly at the level of the lateral and inferolateral walls | -increased diffuse | -increased diffuse | -hypersignal at the LGE level |
CMR parameters_ Predictor of significant clinical impact-univariable analysis
| Predictor | N | Event N | OR (95% CI) |
p-value |
|---|---|---|---|---|
| 272 | 180 | 0.97 (0.95 to 0.99) | 0.002 | |
| 272 | 180 | 1.01 (1.00 to 1.01) | 0.067 | |
| 272 | 180 | 1.01 (1.00 to 1.02) | 0.012 | |
| 272 | 180 | 0.98 (0.96 to 1.00) | 0.026 | |
| 265 | 175 | 0.97 (0.95 to 0.99) | 0.002 | |
| 177 | 113 | 1.84 (1.11 to 3.07) | 0.019 | |
| 243 | 157 | 1.00 (1.00 to 1.01) | 0.507 | |
| 254 | 167 | 0.99 (0.93 to 1.01) | 0.387 |
Demographic Parameters_ Predictor of significant clinical impact - univariable analysis
| Predictor | N | Event N | OR (95% CI) |
p-value |
|---|---|---|---|---|
| 272 | 180 | 1.00 (0.99 to 1.02) | 0.733 | |
| 179 | 121 | 1.20 (0.71 to 2.03) | 0.492 | |
| 272 | 180 | 1.22 (0.53 to 2.96) | 0.643 | |
| 57 | 41 | 1.39 (0.74 to 2.71) | 0.312 | |
| 151 | 102 | 1.16 (0.70 to 1.93) | 0.559 | |
| 140 | 95 | 1.18 (0.71 to 1.96) | 0.517 | |
| 12 | 10 | 2.66 (0.68 to 17.6) | 0.212 | |
| 40 | 28 | 1.24 (0.61 to 2.64) | 0.568 | |
| 1 | 29 | 19 | — | |
| 2 | 176 | 110 | 0.88 (0.37 to 1.96) | 0.755 |
| 3 & 4 | 36 | 29 | 2.18 (0.72 to 6.97) | 0.175 |
CMR parameters
| Cardiac dimensions and function | |
|---|---|
| LVEDV, ml | 224 (±100) |
| LVEDVi, ml/m2 | 113(± 47) |
| LVESV, ml | 129 (±92) |
| LVESVi, ml/m2 | 64 (±43) |
| LVSV | 92 (±58) |
| LVEF, % | 46 (±15) |
| LV mass i, g/m2 | 68(±27) |
| RVEDV, ml | 168 (±58) |
| RVEDVi, ml/m2 | 81 (±29) |
| RVESV, ml | 89 (±27) |
| RVESVi, ml/m2 | 43 (±26) |
| RVEF% | 55 (±11) |
| Oedema n, (%) | 15, (4,2%) |
| Native T1 (ms) | 1030(±50) |
| T2 (ms) | 49 (±19) |
| Scar present n, (%) | 177 (65%) |
| Non-ischaemic scar n, (%) | 164 (92%) |
| Ischaemic scar n, (%) | 13 (7.3%) |
| Number of scars (%)
· 1 scar · 2 scars · 3 scars · >3 scars |
· 91 (51.4%) · 38 (21.4%) · 14 (7.9%) · 34 (19.2%) |
Baseline characteristics
| Age, years | 49 (±14) |
| Sex (male), % | 65% |
| Body surface area, m2 | 1.99 (±0.2) |
| Family history of cardiomyopathy | 4% |
| 21% | |
| 65% | |
| 13% | |
| 1% | |
| Hypertension, % | 55% |
| Diabetes mellitus, % | 3% |
| Hypercholesterolemia, % | 51% |
| Smoking % | 15% |
| Alcohol consumption, % | 4.5% |
| History of myocardial infarction, % | 0.5% |
| Aortocoronary bypass operation, % | 0% |
| PCI, % | 0.5% |
| CKD, % | 5% |
| Sinus Rhythm, % | 93% |
| Atrial Fibrillation, % | 7% |
| Complete LBBB, % | 12% |
| Frequent PVC, % | 7% |
| 0.5% | |
| Echocardiography | 100% |
| Coronary angiogram CT | 1% |
| Coronary angiography | 20% |
| SPECT | 1% |
| Treadmill test | 2% |
| DCM/ NDLVC | 45% |
| HCM/ LVH | 18% |
| Cardiac amyloidosis | 5.2% |
| ARVC | 4 % |
| Myocarditis | 3.6% |
| Cardiac sarcoidosis | 1% |
| LV non-compaction/hypertrabeculation | 2% |
| Anderson-Fabry disease | 2% |
| Tachycardia-induced cardiomyopathy | 1% |
| Chemotherapy induces cardiomyopathy | 0.5% |
| Neuromuscular cardiomyopathy | 0.5% |
| Arrhythmia/SND substrate | 2.5% |
| Ischemic cardiomyopathy | 1% |
| Other cardiomyopathy | 10% |
CMR parameters_ Multiple univariate binominal logistic regression
| Predictor | N | SCI N | OR (95% CI) |
p-value | VIF |
|---|---|---|---|---|---|
| LVESVi | 272 | 180 | 1.01 (1.005 to 1.02) | 0.021 | 1.0 |
| LGE | 177 | 113 | 1.72 (1.03 to 2.89) | 0.038 |