Abstract 1926: The Prevalence and Distribution of Late Gadolinium Enhancement by Cardiac Magnetic Resonance in Chronic Kidney Disease Patients at High Risk for Cardiovascular Events
BACKGROUND. The prevalence and distribution of late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) in chronic kidney disease patients on hemodialysis (CKD) is not well described. Potential etiologies of LGE in CKD include myocardial infarction, fibrosis from left ventricular hypertrophy (LVH), or an inflammatory/infiltrative process.
METHODS. CMR was performed on CKD patients on a Siemens Avanto 1.5-T scanner. CMR included steady state free precession (TR 2.7 ms, TE 1.28 ms, Flip angle 73° FOV 300–350 mm, resolution 1.8 x 1.4 x 8.0 mm) and post-gadolinium phase sensitive inversion recovery sequences (TR 700 ms, TE 4.18 ms, inversion time 300 ms, flip angle 25° FOV 300 – 340 mm, resolution 1.8 x 1.3 x 8 mm). LGE was defined as signal intensity 2 S.D. > that of remote nonenhanced myocardium.
RESULTS. 15 patients (age 57 ± 7 years, 60% males, 87% African American, dialysis for 49 ± 40 months, 100% hypertension, 67% diabetes, 47% coronary artery disease) underwent CMR. LV ejection fraction was 49 ± 18% and LV mass (LVM) index 94 ± 39 g/m2. LGE was seen in 73% (11 of 15) of patients in 3 distinct patterns (Figure⇓). Infarct-related subendocardial LGE in a coronary distribution (panel A) was present in 18% (2 of 11). A concentric diffuse pattern was seen in 18% (panel B). Patchy LGE distribution was most common (panel C), seen in 64% (7 of 11). LGE constituted 18 ± 21 percent of the total LVM. Linear regression analysis showed a significant relationship between LVM and LGE (r = 0.69, p = 0.004).
CONCLUSION: LGE is prevalent in CKD patients and the extent is related to LVM. The majority of LGE is not infarct-related and may represent fibrosis due to LVH and/or an inflammatory/infiltrative process.