Quantification of late gadolinium enhanced CMR in viability assessment in chronic ischemic heart disease: a comparison to functional outcome.
BACKGROUND
Quantification of late gadolinium enhanced cardiovascular magnetic resonance (LGE CMR) 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 1 month before and cine CMR 6 months after coronary revascularization. Enhancement was quantified by thresholding window setting at: 2-8 SD above mean signal intensity of a remote normal region, and according to the full width at half maximum method (FWHM). Dysfunctional segments were 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 6 SD best predicted segmental functional outcome after revascularization, but the difference with other methods was small and non-significant.


CONCLUSIONS
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.
Beek
Aernout M
AM
Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands. am.beek@vumc.nl
Bondarenko
Olga
O
Afsharzada
Farshid
F
van Rossum
Albert C
AC
D002908:Chronic Disease; D015897:Comorbidity; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology*; D012372:ROC Curve
D003287:Contrast Media; D019786:Gadolinium DTPA