Abstract 14956: Use of Late Gadolinium Enhancement to Differentiate Cardiac Sarcoidosis with Ventricular Dysfunction from End-stage phase of Hypertrophic Cardiomyopathy and dilated cardiomyopahty
Background: Patients with cardiac sarcoidosis (CS) are often initially misdiagnosed with idiopathic dilated cardiomyopathy (DCM) or end-stage phase of hypertrophic cardiomyopathy (Es-HCM) due to the lack of appropriate diagnostic techniques. We sought to identify morphological characteristics of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) that differentiate patients with CS from those with Es-HCM and DCM.
Methods: 23 patients with CS, 35 patients with DCM, and 26 Es-HCM were recruited, and CMR was performed using a 1.5 T MR system. The whole hearts was divided into 29 segments and assessed for LGE morphology and distribution.
Results: LGE was found in all of the patients with CS and Es-HCM, but in 75% of those with DCM. Compared with DCM and Es-HCM, LGE in the right ventricle (RV) was only observed in CS patients (p<0.0001, p<0.0001, respectively). The most commonly affected LGE regions were the LV anteroseptal wall and the RV outflow tract (Fig. A), and these areas demonstrated a patchy pattern that was distributed transmurally or localized to the epicardial layer of the LV. In Es-HCM patients, the cardiac regions most commonly demonstrating LGE were interventricular septum with junctional areas between the RV and LV, and these morphology were transmurally distributed patchy pattern (Fig. B). In DCM, LGE was primarily located in the middle layer of the interventricular septum (IVS) in a linear pattern (Fig. C). The number of LGE segments in patients with CS and ES-HCM was positively correlated with LV end-diastolic volume index and LV end-systolic volume index, and negatively correlated with LV ejection fraction. Intriguingly, none of the above correlations were seen in DCM.
Conclusions: Our data indicates that specific reproducible LGE patterns are present in patients with CS and Es-HCM. Thus, assessment of LGE has the potential to provide valuable information to distinguish CS and Es-HCM from DCM.
- © 2011 by American Heart Association, Inc.