Extracellular Volume Fraction in Dilated Cardiomyopathy Patients Without Obvious Late Gadolinium Enhancement: Comparison with Healthy Control Subjects

To evaluate whether the extracellular volume fraction (ECV) measured using cardiac magnetic resonance (CMR) imaging can detect myocardial tissue changes in dilated cardiomyopathy (DCM) without late gadolinium enhancement (LGE). Forty-one DCM patients and 10 healthy volunteers underwent pre- and post-T1 mapping using a modified Look-Locker Inversion recovery sequence, LGE, and cine MRI on a 3-T CMR system. LGE-MR findings were used to divide DCM patients into two groups: Group A had no apparent LGE, and Group B had LGE apparent in at least one segment. The ECV of the left ventricle (LV) myocardium (16 segments) was calculated in the short-axis view as follows: ECV = [(ΔR1 of myocardium/ΔR1 of LV blood pool)] × (1 - hematocrit), where R1 = 1/T1, ΔR1 = post-contrast R1 - pre-contrast R1. The LV ejection fraction (LVEF) was obtained from cine MRI images. The mean myocardial ECV in LGE (-) segments in Group A + B was compared to that of controls. The mean myocardial ECV in Group A was compared to that of LGE (-) segments in Group B. The correlation between LV systolic function and the mean myocardial ECV of the whole myocardium was evaluated in all groups. Among the 41 DCM patients, 22 were in Group A, and 19 were in Group B. The mean ECV of DCM patents (n = 41, 568 segments, 30.7 % ± 5.9) was significantly higher (P < 0.001) than that of the control group (n = 10, 157 segments, 25.6 % ± 3.2). The ECV was inversely related to LVEF in Group A (r = -0.551, P = 0.008), Group B (r = -0.525, P = 0.021), and Group A + B (r = -0.550, P < 0.001). The ECV measured by MRI could be a useful parameter in evaluating diffuse myocardial changes in DCM patients.