Free-Breathing, Motion-Corrected Late Gadolinium Enhancement Is Robust and Extends Risk Stratification to Vulnerable Patients

• DOI: 10.1161/circimaging.112.000022
• Publication Date: 2013-04-19T04:59:54Z
• Authors: Kayla M. Piehler; Timothy C. Wong; Kathy S. Puntil; Karolina M. Zareba; Kathie Lin; David M. Harris; Christopher R. De...; Joan M. Lacomis; Ferenc Czeyda-Pom...; Stephen C. Cook; Peter Kellman; Erik B. Schelbert
• Keywords: Adult; Heart Failure; Male; Chi-Square Distribution; Cardiac-Gated Imaging Techniques; Contrast Media; Magnetic Resonance Imaging, Cine; Gadolinium; Middle Aged; 3. Good health; Breath Holding; Hospitalization; 03 medical and health sciences; Logistic Models; 0302 clinical medicine; Heterocyclic Compounds; Image Interpretation, Computer-Assisted; Disease Progression; Linear Models; Humans; Female; Artifacts; Aged

Background— 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.

Methods and Results—

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).

Conclusions— 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.