Quantification of late gadolinium enhanced CMR in viability assessment in chronic ischemic heart disease: a comparison to functional outcome

Abstract
Background: Quantification of late gadolinium enhanced cardiovascular magnetic resonance (LGECMR) by objective window setting increases reproducibility and facilitates multicenter comparison and cooperation. So far, quantification methods or models have only been validated to postmortem animal studies. This study was undertaken to evaluate quantification of LGE in relation to the clinical standard of viability, i.e. functional outcome after revascularization.

Thirty-eight patients with chronic ischemic myocardial dysfunction underwent cine and LGE 1month before and cine CMR 6 months after coronary revascularization. Enhancement was quantified by thresholding window setting at: 2-8SD above mean signal intensity of a remote normal region, and according to the full width at half maximum method (FWHM). Dysfunctional segmentswere divided in 5 groups according to segmental extent of enhancement (SEE): SEE 1 – no enhancement to SEE 5 – 76–100% with each quantification method.

Results: Quantification methods had a strong influence on SEE and total infarct size. Multilevel
analysis showed that thresholding contrast images at 6SD best predicted segmental functional outcome after revascularization, but the difference with other methods was small and nonsignificant.

Conclusion: Simple thresholding techniques strongly influence global and segmental extent of
LGE, but have relatively little influence on the accuracy to predict segmental functional improvement after revascularization.

Journal of Cardiovascular Magnetic Resonance 2009, 11:6

Realmente queda claro el papel que juega la RMC a través de la técnica de Realce Tardío en la detección de zonas infartadas, para predecir mejora o no de la función ventricular después de la Revascularización Miocardica quirúrgica o percutánea.

Florangel Martínez. Centro Clinico Valentina Canabal. Barquisimeto. Venezuela.