Assessment of Myocardial Fibrosis Using LGE with CMR
While the clinical use of LGE for assessment of myocardial fibrosis in
both ischemic and non-ischemic heart disease has been a relatively
recent advance, the concept of differential enhancement of the diseased
myocardium by CMR was described more a few decades ago109,
110. Early animal studies with
controlled ischemia models showed no LGE of reversibly injured
myocardium, but evidence of LGE in irreversibly damaged
myocardium.111-114These early animal studies were proof of concept that LGE by CMR could
be a sensitive marker of myocardial fibrosis. This led to application of
the technique in myocardial infarction patients in the late 1980’s115. Advancements in
CMR and LGE pulse sequences improved the ability to differentiate
between normal and fibrotic myocardium and led to widespread clinical
application 44-47,
116-118. Multiple studies in adult
patients with ischemic heart disease showed that LGE by CMR was precise
and reliable for demonstrating the presence, location, and extent of
myocardial fibrosis 45,
117,
119-125. An international multicenter
study reported a sensitivity of 99% for detecting acute infarction and
94% for detecting chronic infarction116 The ability of CMR
to detect myocardial fibrosis led to application of the technique in
non-ischemic heart disease. Over the last decades numerous studies
demonstrated LGE by CMR is able to detect myocardial fibrosis in both
ischemic and non-ischemic heart disease including DMD-CM33,
51, 56,
80, 117,
118,
126,
127. Detecting LGE with CMR is now
routinely used at our institution for both cardiomyopathy and congenital
heart disease patients, including our large population of DMD patients.