• LGE
• non-ischemic late gadolinium enhancement
• stress perfusion cardiac magnetic resonance
• stress-CMR

Purpose: Stress perfusion cardiac magnetic resonance (stress-CMR) provides information on myocardial ischemia and fibrosis using Late Gadolinium Enhancement (LGE). Usually an ischemic pattern of LGE (I-LGE) is expected and most frequent. However, non-ischemic LGE (NI-LGE) can be occasionally found suggesting alternative diagnosis. Aim: to assess the prevalence and prognostic significance of NI-LGE in patients undergoing stress-CMR.
Methods: Stress-CMR with either dipyridamole or adenosine was performed in 283 patients (228 males, 81%) including perfusion imaging, wall motion evaluation and LGE. Follow-up was completed in all enrolled patients (median time: 1850 days; interquartile range: 1225-2705 days). Composite endpoint included cardiac death, ventricular tachycardia, myocardial infarction, stroke, hospitalization for cardiac cause and coronary revascularization performed beyond 90 days from stress-CMR scans.
Results: One hundred and twelve patients (40%) had negative LGE (no-LGE), 140 patients (49%) I-LGE and 31 patients (11%) NI-LGE. Twenty-five events occurred in the no-LGE group, 68 in I-LGE and 11 in the NI-LGE group. On survival curves, patients with NI-LGE had worse prognosis than patients with no-LGE regardless of the presence of inducible perfusion defects (IPD). No significant prognostic differences were found between I-LGE and NI-LGE.
Conclusions: NI-LGE can be detected in 11% of patients during stress-CMR providing a diagnosis of non-ischemic cardiac disease. Patients with NI-LGE have worse prognosis than those with no-LGE.