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Patterns of late gadolinium enhancement in chronic hemodialysis patients

Brian J Schietinger1, Glenn M Brammer, Hongkun Wang

  • 1Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908, USA.

JACC. Cardiovascular Imaging
|April 10, 2009
PubMed

Insights

Late gadolinium enhancement (LGE) is common in hemodialysis patients and linked to left ventricular mass. Most LGE is not infarct-related, indicating potential fibrosis or infiltrative processes in dysfunctional heart segments.

Area of Science:

  • Cardiovascular Imaging
  • Nephrology
  • Cardiac MRI

Background:

  • Hemodialysis patients face high cardiovascular event risk.
  • Prevalence and patterns of late gadolinium enhancement (LGE) in this population are unknown.
  • Relationship between LGE, left ventricular mass (LVM), and function needs clarification.

Purpose of the Study:

  • To characterize late gadolinium enhancement (LGE) patterns using cardiovascular magnetic resonance imaging (CMR) in hemodialysis patients.
  • To assess the relationship between LGE, left ventricular mass (LVM), and left ventricular function in this high-risk group.

Main Methods:

  • 24 chronic hemodialysis patients underwent cardiovascular magnetic resonance imaging (CMR).
  • CMR included cine imaging and late gadolinium-enhanced (LGE) sequences.
  • Analysis involved calculating LVM, volumes, function, and LGE distribution across 16 left ventricular segments.

Main Results:

  • Late gadolinium enhancement (LGE) was observed in 79% of patients.
  • Three LGE patterns emerged: infarct-related (32%), diffuse (37%), and focal noninfarct (37%).
  • LGE correlated with LVM (r=0.44, p=0.03) and was inversely related to segmental wall thickening (p>0.0001).

Conclusions:

  • Late gadolinium enhancement (LGE) is prevalent in hemodialysis patients and associated with increased left ventricular mass (LVM).
  • Non-infarct-related LGE is common and linked to hypertrophied, dysfunctional left ventricular segments.
  • Further research in this population is limited by nephrogenic systemic fibrosis risk.
Abstract

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