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.