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The impact of dark-blood versus conventional bright-blood late gadolinium enhancement on the myocardial ischemic burden

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Article number109947
JournalEuropean Journal of Radiology
Volume144
Early online date8 Oct 2021
DOIs
E-pub ahead of print8 Oct 2021
PublishedNov 2021

Bibliographical note

Funding Information: This work was supported by the British Heart Foundation [PG/18/71/34009 and TG/18/2/33768]; King's College London & Imperial College London EPSRC Centre for Doctoral Training in Medical Imaging [EP/L015226/1]; Philips Healthcare; The Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas? NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust; The NIHR Cardiovascular MedTech Co-operative; and The Centre of Excellence in Medical Engineering funded by the Wellcome Trust and EPSRC [WT 203148/Z/16/Z]. The views expressed are those of the authors and not necessarily those of the NHS or funding bodies. The funding bodies did not have a role in the design of the study and collection, analysis, and interpretation of data or writing of the manuscript. Funding Information: This work was supported by the British Heart Foundation [ PG/18/71/34009 and TG/18/2/33768 ]; King’s College London & Imperial College London EPSRC Centre for Doctoral Training in Medical Imaging [EP/L015226/1]; Philips Healthcare; The Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust; The NIHR Cardiovascular MedTech Co-operative; and The Centre of Excellence in Medical Engineering funded by the Wellcome Trust and EPSRC [WT 203148/Z/16/Z]. The views expressed are those of the authors and not necessarily those of the NHS or funding bodies. The funding bodies did not have a role in the design of the study and collection, analysis, and interpretation of data or writing of the manuscript. Publisher Copyright: © 2021

King's Authors

Abstract

Purpose: In perfusion cardiovascular magnetic resonance (CMR), ischemic burden predicts adverse prognosis and is often used to guide revascularization. Ischemic scar tissue can cause stress perfusion defects that do not represent myocardial ischemia. Dark-blood late gadolinium enhancement (LGE) methods detect more scar than conventional bright-blood LGE, however, the impact on the myocardial ischemic burden estimation is unknown and evaluated in this study. Methods: Forty patients with CMR stress perfusion defects and ischemic scar on both dark-blood and bright-blood LGE were included. For dark-blood LGE, phase sensitive inversion recovery imaging with left ventricular blood pool nulling was used. Ischemic scar burden was quantified for both methods using >5 standard deviations above remote myocardium. Perfusion defects were manually contoured, and the myocardial ischemic burden was calculated by subtracting the ischemic scar burden from the perfusion defect burden. Results: Ischemic scar burden by dark-blood LGE was higher than bright-blood LGE (13.3 ± 7.4% vs. 10.3 ± 7.1%, p < 0.001). Dark-blood LGE derived myocardial ischemic burden was lower compared with bright-blood LGE (15.6% (IQR: 10.3 to 22.0) vs. 19.3 (10.9 to 25.5), median difference −2.0%, p < 0.001) with a mean bias of −2.8% (95% confidence intervals: −4.0 to −1.6%) and a large effect size (r = 0.62). Conclusion: Stress perfusion defects are associated with higher ischemic scar burden using dark-blood LGE compared with bright-blood LGE, which leads to a lower estimation of the myocardial ischemic burden. The prognostic value of using a dark-blood LGE derived ischemic burden to guide revascularization is unknown and warrants further investigation.

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