title: Occurrence of late gadolinium enhancement is associated with increased left ventricular wall stress and mass in patients with non-ischaemic dilated cardiomyopathy.
abstract: OBJECTIVE
  Occurrence of late gadolinium enhancement (LGE) as assessed by cardiac magnetic resonance (CMR) imaging has been attributed to various myocardial injuries. We hypothesized that LGE is associated with left ventricular (LV) wall stress.
  
  
  RESULTS
  We examined 300 patients with suspected non-ischaemic dilated cardiomyopathy. Cardiac magnetic resonance was used to assess LV volume, mass, wall stress, and LGE. Increased LV end-diastolic wall stress (> 4 kPa) was found in 112 patients (37 %), and increased end-systolic wall stress (>18 kPa) in 121 patients (40%). Presence of LGE was observed in 93 patients (31%). End-diastolic (94 ± 43 vs. 79 ± 42 ml/m(2), P = 0.006) and end-systolic LV volumes (62 ± 44 vs. 44 ± 37 ml/m(2), P < 0.001) and LV mass (95 ± 34 vs. 78 ± 31 g/m(2), P < 0.001) were increased in patients exhibiting LGE. In particular, LV end-diastolic and end-systolic wall stress were increased (4.5 ± 2.8 vs. 3.6 ± 3.0 kPa, P = 0.025; 19.6 ± 9.1 vs. 17.5 ± 8.2 kPa, P = 0.045). Late gadolinium enhancement was observed more frequently than would be expected from random occurrence in patients with increased end-diastolic (39 vs. 26%, P = 0.020) and end-systolic wall stress (41 vs. 24%, P = 0.002). Both normal end-diastolic and end-systolic wall stress had a high negative predictive value for LGE (75 and 76%).
  
  
  CONCLUSIONS
  The present study shows that occurrence of LGE in cardiomyopathy is associated with increased LV wall stress and mass. Suspected causes are an increased capillary leakage by stretch, impaired contrast agent redistribution, or increased diffusion distances. It is proposed that LGE should be considered as a potential prognostic determinant of heart failure and severe arrhythmias.
authors.affiliation: Department of Internal Medicine-Cardiology, Philipps University, Marburg, Germany. alter@staff.uni-marburg.de
authors.forename: Peter
authors.initials: P
authors.lastname: Alter
authors.forename: Heinz
authors.initials: H
authors.lastname: Rupp
authors.forename: Philipp
authors.initials: P
authors.lastname: Adams
authors.forename: Florian
authors.initials: F
authors.lastname: Stoll
authors.forename: Jens H
authors.initials: JH
authors.lastname: Figiel
authors.forename: Klaus J
authors.initials: KJ
authors.lastname: Klose
authors.forename: Marga B
authors.initials: MB
authors.lastname: Rominger
authors.forename: Bernhard
authors.initials: B
authors.lastname: Maisch
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000473:pathology
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA