PMID- 19356466
OWN - NLM
STAT- MEDLINE
DCOM- 20090603
LR  - 20211020
IS  - 1876-7591 (Electronic)
IS  - 1936-878X (Print)
IS  - 1876-7591 (Linking)
VI  - 1
IP  - 4
DP  - 2008 Jul
TI  - Patterns of late gadolinium enhancement in chronic hemodialysis patients.
PG  - 450-6
LID - 10.1016/j.jcmg.2008.03.011 [doi]
AB  - OBJECTIVES: The aim of this work was to characterize patterns of late gadolinium 
      enhancement (LGE) by cardiovascular magnetic resonance imaging in a hemodialysis 
      population at high risk for cardiovascular events. BACKGROUND: The prevalence and 
      distribution of LGE and its relationship to left ventricular mass (LVM) and 
      function in this population is unknown. METHODS: Chronic hemodialysis patients at 
      high risk for cardiovascular events-age >50 years, diabetes, or known 
      cardiovascular disease-were enrolled prior to concerns regarding nephrogenic 
      systemic fibrosis. Cardiovascular magnetic resonance imaging was performed in 24 
      patients (age, 59 +/- 11 years; dialysis, 45 +/- 38 months) and included 
      steady-state free precession cine imaging and late gadolinium-enhanced, 
      phase-sensitive, inversion-recovery gradient echo images. Left ventricular mass, 
      volumes, and function were calculated and indexed to body surface area. A 
      16-segment analysis was performed to calculate percentage of LGE, LV wall 
      thickness, and percentage of wall thickening. RESULTS: Left ventricular ejection 
      fraction was 48 +/- 15%, and the LV mass index was 100 +/- 52 g/m(2). Late 
      gadolinium enhancement was observed in 79% (19 of 24) of patients in 3 distinct 
      patterns: infarct-related (32%, 6 of 19), diffuse (37%, 7 of 19), and focal 
      noninfarct (37%, 7 of 19). Late gadolinium enhancement constituted 15 +/- 18% of 
      the LVM and correlated with LVM (r = 0.44, p = 0.03). A significant, inverse 
      relationship existed between segmental LGE and the percentage of wall thickening 
      (p > 0.0001). Excluding infarct-related segments, as end-diastolic wall thickness 
      increased, so did LGE (p < 0.0001), and as LGE increased, the percentage of wall 
      thickening decreased (p = 0.0012). After 23 +/- 3 months of follow-up, 1 patient 
      had developed nephrogenic systemic fibrosis. Seven of the patients (29%) had 
      developed a hard cardiovascular event, 5 of 19 (26%) with LGE and 2 of 5 (40%) 
      without. CONCLUSIONS: Late gadolinium enhancement is prevalent in the 
      hemodialysis population and its extent is related to LVM. Most cases of LGE are 
      not infarct-related and are associated with hypertrophied, dysfunctional LV 
      segments. Non-infarct-related LGE may signify fibrosis from LV hypertrophy and/or 
      an infiltrative process. Further studies in this patient population will not be 
      possible due to the risk of nephrogenic systemic fibrosis.
FAU - Schietinger, Brian J
AU  - Schietinger BJ
AD  - Department of Medicine, University of Virginia Health System, Charlottesville, 
      Virginia 22908, USA.
FAU - Brammer, Glenn M
AU  - Brammer GM
FAU - Wang, Hongkun
AU  - Wang H
FAU - Christopher, John M
AU  - Christopher JM
FAU - Kwon, Katherine W
AU  - Kwon KW
FAU - Mangrum, Amy J
AU  - Mangrum AJ
FAU - Mangrum, J Michael
AU  - Mangrum JM
FAU - Kramer, Christopher M
AU  - Kramer CM
LA  - eng
GR  - R01 HL075792/HL/NHLBI NIH HHS/United States
GR  - T32 EB003841/EB/NIBIB NIH HHS/United States
GR  - T32 EB003841-05/EB/NIBIB NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - JACC Cardiovasc Imaging
JT  - JACC. Cardiovascular imaging
JID - 101467978
RN  - 0 (Contrast Media)
RN  - 84F6U3J2R6 (gadodiamide)
RN  - K2I13DR72L (Gadolinium DTPA)
SB  - IM
CIN - JACC Cardiovasc Imaging. 2008 Jul;1(4):457-9. PMID: 19356467
MH  - Adult
MH  - Aged
MH  - Cardiovascular Diseases/*diagnosis/etiology/physiopathology
MH  - *Contrast Media/adverse effects
MH  - Female
MH  - Fibrosis
MH  - *Gadolinium DTPA/adverse effects
MH  - Humans
MH  - Hypertrophy, Left Ventricular/diagnosis/etiology
MH  - Kidney Failure, Chronic/complications/*therapy
MH  - *Magnetic Resonance Imaging, Cine/adverse effects
MH  - Male
MH  - Middle Aged
MH  - Nephrogenic Fibrosing Dermopathy/etiology
MH  - *Renal Dialysis
MH  - Risk Assessment
MH  - Risk Factors
MH  - Stroke Volume
MH  - Ventricular Dysfunction, Left/diagnosis/etiology
MH  - Ventricular Function, Left
PMC - PMC2933143
MID - NIHMS230666
EDAT- 2009/04/10 09:00
MHDA- 2009/06/06 09:00
PMCR- 2010/09/03
CRDT- 2009/04/10 09:00
PHST- 2007/11/02 00:00 [received]
PHST- 2008/02/27 00:00 [revised]
PHST- 2008/03/20 00:00 [accepted]
PHST- 2009/04/10 09:00 [entrez]
PHST- 2009/04/10 09:00 [pubmed]
PHST- 2009/06/06 09:00 [medline]
PHST- 2010/09/03 00:00 [pmc-release]
AID - S1936-878X(08)00170-8 [pii]
AID - 10.1016/j.jcmg.2008.03.011 [doi]
PST - ppublish
SO  - JACC Cardiovasc Imaging. 2008 Jul;1(4):450-6. doi: 10.1016/j.jcmg.2008.03.011.