Free-breathing, motion-corrected late gadolinium enhancement is robust and extends risk stratification to vulnerable patients

• Published in: Circulation. Cardiovascular imaging Vol. 6; no. 3; pp. 423 - 432
• Main Authors: Piehler, Kayla M, Wong, Timothy C, Puntil, Kathy S, Zareba, Karolina M, Lin, Kathie, Harris, David M, Deible, Christopher R, Lacomis, Joan M, Czeyda-Pommersheim, Ferenc, Cook, Stephen C, Kellman, Peter, Schelbert, Erik B
• Format: Journal Article
• Language: English
• Published: United States 01.05.2013
• Subjects: Adult; Aged; Breath Holding; Cardiac-Gated Imaging Techniques; Chi-Square Distribution; Contrast Media; Disease Progression; Female; Gadolinium; Heart Failure - mortality; Heart Failure - therapy; Heterocyclic Compounds; Hospitalization; Humans; Image Interpretation, Computer-Assisted; Linear Models; Logistic Models; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - pathology; Myocardial Infarction - therapy; Myocardium - pathology; Odds Ratio; Organometallic Compounds; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Respiration; Risk Factors; Time Factors; MRI; myocardial delayed enhancement; myocardial infarction
• ISSN: 1941-9651; 1942-0080
• DOI: 10.1161/CIRCIMAGING.112.000022

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. 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). 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.