Evidence of an increased incidence of myocardial inflammation associated with reduced ventricular function in clinically
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POSTER PRESENTATION
Open Access
Evidence of an increased incidence of myocardial inflammation associated with reduced ventricular function in clinically suspected idiopathic dilated cardiomyopathy - a cardiovascular magnetic resonance study Oliver Strohm1, Myra S Cocker1*, Tak S Fung2, Saleh Kary1, Helene Childs1, Matthias G Friedrich1 From 2011 SCMR/Euro CMR Joint Scientific Sessions Nice, France. 3-6 February 2011 Background Dilated cardiomyopathy (DCM) occurring due to an unknown etiology or genetic predisposition is termed as idiopathic dilated cardiomyopathy (iDCM), although iDCM may also result from viral exposure. However, the incidence of myocardial inflammation and its relation to left ventricular (LV) function in iDCM remains unknown. Cardiovascular magnetic resonance (CMR) imaging allows for the visualization of myocardial inflammation using early Gadolinium enhancement (EGE). We applied EGE imaging in the setting of clinically suspected iDCM to determine both the incidence and relation of myocardial inflammation to LV function. Methods 26 patients (17 males, age 44±14 years old) were referred to us for the assessment of iDCM following a clinical suspicion of iDCM, based upon the following criteria: ejection fraction below 45%; invasive exclusion of significant coronary artery disease using a cutoff of 50% stenosis; stable clinical course for at least 3-months prior to the CMR study; exclusion of myocarditis within the past 12 months; as well as exclusion of comorbidities which may otherwise account for patient presentation including valvular heart disease. 1 Stephenson Cardiovascular Magnetic Resonance Centre, Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Radiology, University of Calgary, Calgary, AB, Canada Full list of author information is available at the end of the article
Standard CMR imaging procedures for the assessment of LV function and EGE were utilized. EGE images were acquired before and early after (over 4 minutes) Gd-DTPA 0.1ml/kgBW contrast injection using T1-weighted images. LV function was assessed by manually tracing endoand epicardial contours. Myocardial signal intensity was normalized to skeletal muscle, generating a ratio that had to be greater than or equal to 4 to be considered positive for EGE.
Results Eighteen patients (69%) presented with EGE and a significantly increased EGE ratio (7.4±3.6 vs. 2.9±0.7, p=0.002). The ratio of EGE correlated with LVEDVI (r=0.530, p=0.005) and LVESVI (r=0.596, p=0.001), LVSVI (r=-0.437, p=0.260), and LVEF (r=-0.633, p=0.001). Patients with elevated EGE had significantly dilated left ventricles and globally reduced ventricular function: LVEDVI (167.1±47.8 ml/m vs. 111.9±28.6 ml/m, p=0.006) and LVESVI (130.9±48.0 ml/m vs. 57.3±17.3 ml/m, p
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