title: Free-breathing, motion-corrected late gadolinium enhancement is robust and extends risk stratification to vulnerable patients.
abstract: BACKGROUND
  Routine clinical use of novel free-breathing, motion-corrected, averaged late-gadolinium-enhancement (moco-LGE) cardiovascular MR may have advantages over conventional breath-held LGE (bh-LGE), especially in vulnerable patients.
  
  
  RESULTS
  In 390 consecutive patients, we collected bh-LGE and moco-LGE with identical image matrix parameters. In 41 patients, bh-LGE was abandoned because of image quality issues, including 10 with myocardial infarction. When both were acquired, myocardial infarction detection was similar (McNemar test, P=0.4) with high agreement (κ=0.95). With artifact-free bh-LGE images, pixelwise myocardial infarction measures correlated highly (R(2)=0.96) without bias. Moco-LGE was faster, and image quality and diagnostic confidence were higher on blinded review (P<0.001 for all). During a median of 1.2 years, 20 heart failure hospitalizations and 18 deaths occurred. For bh-LGE, but not moco-LGE, inferior image quality and bh-LGE nonacquisition were linked to patient vulnerability confirmed by adverse outcomes (log-rank P<0.001). Moco-LGE significantly stratified risk in the full cohort (log-rank P<0.001), but bh-LGE did not (log-rank P=0.056) because a significant number of vulnerable patients did not receive bh-LGE (because of arrhythmia or inability to hold breath).
  
  
  CONCLUSIONS
  Myocardial infarction detection and quantification are similar between moco-LGE and bh-LGE when bh-LGE can be acquired well, but bh-LGE quality deteriorates with patient vulnerability. Acquisition time, image quality, diagnostic confidence, and the number of successfully scanned patients are superior with moco-LGE, which extends LGE-based risk stratification to include patients with vulnerability confirmed by outcomes. Moco-LGE may be suitable for routine clinical use.
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15101, USA.
authors.forename: Kayla M
authors.initials: KM
authors.lastname: Piehler
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Wong
authors.forename: Kathy S
authors.initials: KS
authors.lastname: Puntil
authors.forename: Karolina M
authors.initials: KM
authors.lastname: Zareba
authors.forename: Kathie
authors.initials: K
authors.lastname: Lin
authors.forename: David M
authors.initials: DM
authors.lastname: Harris
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Deible
authors.forename: Joan M
authors.initials: JM
authors.lastname: Lacomis
authors.forename: Ferenc
authors.initials: F
authors.lastname: Czeyda-Pommersheim
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Cook
authors.forename: Peter
authors.initials: P
authors.lastname: Kellman
authors.forename: Erik B
authors.initials: EB
authors.lastname: Schelbert
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D062485:Breath Holding; D055424:Cardiac-Gated Imaging Techniques; D016009:Chi-Square Distribution; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D005682:Gadolinium; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D006571:Heterocyclic Compounds; D006760:Hospitalization; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016014:Linear Models; D016015:Logistic Models; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009206:Myocardium / Q000473:pathology*; D016017:Odds Ratio; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012119:Respiration; D012307:Risk Factors; D013997:Time Factors
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium
keywords: MRI; myocardial delayed enhancement; myocardial infarction