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“Ring-like” Late Gadolinium Enhancement: exploring patterns and outcomes
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 16 – AVANÇOS NO DIAGNÓSTICO E TRATAMENTO DAS MIOCARDIOPATIAS
Speaker:
Rita Almeida Carvalho
Congress:
CPC 2025
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.3 Cardiac Magnetic Resonance
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Almeida Carvalho; Débora Correia; Rita Amador; Sérgio Maltês; Gonçalo Cunha; Pedro Lopes; Catarina Brízido; Christopher Strong; João Abecasis; Bruno Rocha; Carlos Aguiar; António Ferreira
Abstract
<p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.5pt">Background:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.5pt">Left ventricular (LV) scar with a “ring-like” pattern detected by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) has been associated with an increased risk for ventricular arrhythmias and sudden cardiac death (SCD). However, the used definition varies between studies. We aimed to assess the differences across available definitions.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.5pt">Methods:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.5pt">Retrospective single-center study of consecutive patients undergoing CMR and LGE study. A “ring-like” pattern was broadly identified by the presence of non-subendocardial (mid-wall and/or sub-epicardial) LGE involving at least three adjacent myocardial segments, as per the standardized AHA 17-segment model. Those with acute myocarditis and specific myocardial diseases (other than dilated cardiomyopathy) were excluded. The primary endpoint was a composite of death, sustained ventricular tachycardia (VT), or implantable cardioverter-defibrillator (ICD) shocks.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.5pt">Results:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.5pt">Among 4528 patients undergoing CMR, 210 (4.6%) exhibited a “ring-like” pattern, of whom 88 (42%) were excluded due to specific etiologies. Thus, 122 patients were assessed (mean age 60±18 years; 80% male; 61% NYHA I; mean left ventricular ejection fraction (LVEF) 42±14%; family history of cardiomyopathy or SCD in 5%). Mixed mid-wall and sub-epicardial patterns predominated (53%), followed by isolated mid-wall (34%). LGE was most prevalent in the basal segments (88%), followed by mid (48%) and apical walls (36%), involving 7±3 segments overall and 4±1 segments per ring.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.5pt">During a median follow-up of 12 (4-22) months, 25 (20%) patients had an event of the primary endpoint (13 VT, 7 deaths and 5 ICD shocks). These patients were older (67±10 <em>vs.</em> 58±19 years, p=0.032), more often with SCD in first degree family members (12% <em>vs.</em> 3%, p=0.044), with more cardiovascular symptoms (palpitations 40% <em>vs.</em> 18%, p=0.007; syncope 36% <em>vs.</em> 7%, p<0.001), structural heart disease (LVEF 36±13% <em>vs.</em> 43±14%, p=0.028; LV end-diastolic volume 233±59 <em>vs.</em> 193±64 mL, p=0.006), and higher native T1 mapping values (1079±85 <em>vs.</em> 1033±52ms, p=0.008). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.5pt">Patients with an event of the primary endpoint had a higher number of overall segments with mid-wall or sub-epicardial LGE (9±4 <em>vs.</em> 7±3; p<0.001), even though the number of segments involved in each ring <em>per se</em> was similar to other patients (4±1 <em>vs.</em> 4±1; p=0.089). Their rings more frequently exhibited a mixed pattern (68%<em> vs.</em> 48%, p=0.042), having more involvement of the mid (76% <em>vs.</em> 40%, p=0.001) and apical (36% <em>vs.</em> 8%, p<0.001) walls, as well as more often presenting with LGE in the right ventricle (8% <em>vs</em>. 1%, p=0.046).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.5pt">Conclusion: </span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.5pt">Our data suggests that different “ring-like” patterns may have varying degrees of association with the risk of arrhythmic events. Patients with mixed-type “ring-like” involving mid and apical walls were particularly more likely to have had an event of the primary outcome. </span></span></span></p>
Slides
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