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End-systolic versus end-diastolic late gadolinium enhanced imaging for the assessment of scar transmurality

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Abstract

Late gadolinium enhancement (LGE) is widely used to precisely localize and determine the extent and transmurality of myocardial scarring. Performing LGE imaging at end-systole may reduce motion artefacts. It is therefore important to know whether end-systolic imaging influences infarct transmurality in patients with ischemic scar. 107 dysfunctional segments were studied in 20 consecutive patients with established coronary artery disease. Patient specific trigger delays were used to obtain end-diastolic and end-systolic LGE images (LGEed, LGEes). Wall thickness (WTed, WTes), thickness of the remaining viable rim (RIMed, RIMes) and end-diastolic scar thickness were measured manually. There was LGE in 84% of all dysfunctional segments with a mean scar of 3.4 ± 2.5 mm. Total wall thickness and the thickness of the remaining viable rim increased from diastole to systole (WTed 7.8 ± 1.9 vs. WTes 8.4 ± 2.2; P < 0.001; RIMed 4.4 ± 3.1 vs. RIMes 5 ± 3.4; P < 0.001). Transmurality of scar decreased from end-diastole to end-systole (LGEed 46 ± 33% vs. LGEes 44 ± 33%; P < 0.001). This was most pronounced in a subgroup of segments (n = 15) with visual scar transmurality between 50 and 75% (LGEed 75 ± 15% vs. LGEes 70 ± 16%; P < 0.001). The change in transmurality was inversely correlated with the change of the thickness of the remaining viable rim between diastole and systole (r = −0.7; P < 0.001). Scar transmurality was reduced by up to 12% in the individual patient. Scar transmurality changes due to thickening of the remaining viable rim. Whereas these differences might not impact on clinical decision-making in most patients, there will be an occasional misclassification if cut-off values are used (e.g. scar <50 or >50%) or if exact data is required for research studies.

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Acknowledgments

Andreas Schuster receives grant support from the British Heart Foundation (BHF) (RE/08/003 and FS/10/029/28253) and the Biomedical Research Centre (BRC-CTF 196).

Conflict of interest

Eike Nagel received minor consultancy fees from Philips Healthcare and major grant support from Philips Healthcare and Bayer Schering Pharma. The other authors declare that they have no competing interests’.

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Authors and Affiliations

  1. Division of Imaging Sciences and Biomedical Engineering, King’s College London British Heart Foundation (BHF) Centre of Excellence, National Institute of Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre, The Rayne Institute, 4th Floor Lambeth Wing, St. Thomas’ Hospital, London, SE1 7EH, UK

    Andreas Schuster, Amedeo Chiribiri, Masaki Ishida, Geraint Morton, Matthias Paul, Shazia Hussain, Boris Bigalke & Eike Nagel

  2. NIHR Biomedical Research Centre and Department of Cardiology, King’s College London BHF Centre of Excellence, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK

    Divaka Perera

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  1. Andreas Schuster
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  2. Amedeo Chiribiri
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  4. Geraint Morton
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  9. Eike Nagel
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Correspondence to Andreas Schuster.

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Schuster, A., Chiribiri, A., Ishida, M. et al. End-systolic versus end-diastolic late gadolinium enhanced imaging for the assessment of scar transmurality. Int J Cardiovasc Imaging 28, 773–781 (2012). https://doi.org/10.1007/s10554-011-9877-3

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  • DOI: https://doi.org/10.1007/s10554-011-9877-3

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