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World J Cardiol. Jul 26, 2014; 6(7): 585-601
Published online Jul 26, 2014. doi: 10.4330/wjc.v6.i7.585
Distribution of late gadolinium enhancement in various types of cardiomyopathies: Significance in differential diagnosis, clinical features and prognosis
Hiroshi Satoh, Makoto Sano, Kenichiro Suwa, Takeji Saitoh, Mamoru Nobuhara, Masao Saotome, Tsuyoshi Urushida, Hideki Katoh, Hideharu Hayashi
Hiroshi Satoh, Makoto Sano, Kenichiro Suwa, Takeji Saitoh, Mamoru Nobuhara, Masao Saotome, Tsuyoshi Urushida, Hideki Katoh, Hideharu Hayashi, Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
Author contributions: All authors contributed to this paper.
Correspondence to: Hiroshi Satoh, MD, PhD, Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu 431-3192, Japan. satoh36@hama-med.ac.jp
Telephone: +81-53-4352267 Fax: +81-53-4342910
Received: December 20, 2013
Revised: March 21, 2014
Accepted: May 14, 2014
Published online: July 26, 2014
Abstract

The recent development of cardiac magnetic resonance (CMR) techniques has allowed detailed analyses of cardiac function and tissue characterization with high spatial resolution. We review characteristic CMR features in ischemic and non-ischemic cardiomyopathies (ICM and NICM), especially in terms of the location and distribution of late gadolinium enhancement (LGE). CMR in ICM shows segmental wall motion abnormalities or wall thinning in a particular coronary arterial territory, and the subendocardial or transmural LGE. LGE in NICM generally does not correspond to any particular coronary artery distribution and is located mostly in the mid-wall to subepicardial layer. The analysis of LGE distribution is valuable to differentiate NICM with diffusely impaired systolic function, including dilated cardiomyopathy, end-stage hypertrophic cardiomyopathy (HCM), cardiac sarcoidosis, and myocarditis, and those with diffuse left ventricular (LV) hypertrophy including HCM, cardiac amyloidosis and Anderson-Fabry disease. A transient low signal intensity LGE in regions of severe LV dysfunction is a particular feature of stress cardiomyopathy. In arrhythmogenic right ventricular cardiomyopathy/dysplasia, an enhancement of right ventricular (RV) wall with functional and morphological changes of RV becomes apparent. Finally, the analyses of LGE distribution have potentials to predict cardiac outcomes and response to treatments.

Keywords: Cardiomyopathy, Cardiac magnetic resonance, Late gadolinium enhancement, Cardiac function, Clinical features, Prognosis

Core tip: We review characteristic cardiac magnetic resonance (CMR) features in ischemic and non-ischemic cardiomyopathies (NICM), especially in terms of location and distribution of late gadolinium enhancement (LGE). LGE in NICM does not correspond to any particular coronary artery distribution and is located mostly in the mid-wall to subepicardial layer. The analysis of LGE distribution is valuable to differentiate NICM with diffusely impaired systolic function; dilated cardiomyopathy, end-stage hypertrophic cardiomyopathy (HCM), cardiac sarcoidosis, and myocarditis, and those with diffuse LV hypertrophy; HCM, cardiac amyloidosis and Anderson-Fabry disease. The analyses of LGE distribution have potentials to predict cardiac outcomes and response to treatments.