Predictors of late gadolinium enhancement image quality in patients with cardiac devices

Cardiac implantable electronic devices (CIEDs) can cause significant artifacts in late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMR), compromising image quality and diagnostic accuracy. Currently, no consensus exists on optimal patient selection for LGE-CMR in this context.

This study aims to identify predictors of LGE image quality in patients with CIEDs to improve patient-selection for LGE-CMR.

Patients with CIED who underwent conventional, 2-dimensional LGE imaging were retrospectively identified from the AmsterdamUMC CMR database. Baseline clinical characteristics and device specifications were collected, and distance measurements were performed on post-device implantation chest X-ray (Antero-Posterior view), i.e. shortest distance generator to RV lead tip. LGE image quality was categorized as fully diagnostic, moderate, or poor by two independent, experienced CMR readers. Predictors of image quality were then analyzed using clinical and chest X-ray parameters.

75 patients were included in this study (mean age 62 ± 13 years, 70.7% male). The diagnostic quality of CMR scans was as follows: 35 (47%) scans were fully diagnostic, 22 (29%) were moderate (5±1 non-diagnostic segments), and 18 (24%) were poor (11±3 non-diagnostic segments).

A Chi-Square test revealed a significant association between device type and image quality (χ²=27.36, p<0.001). Adjusted residual analysis showed that implantable cardioverter defibrillators (ICDs) were significantly associated with poor image quality (+2.4, p < 0.05), while pacemakers (PMs) were associated with good image quality (+4.7, p < 0.05).

Ordinal regression analysis confirmed that the distance from the generator to RV lead tip was a significant predictor of LGE image quality (p=0.013). ROC analysis identified an optimal threshold of 94.45 mm for the generator-to-RV lead tip distance to maintain diagnostic image quality.

Both device type and spatial positioning significantly impact image quality. Specifically, ICDs were associated with poorer image quality, while PMs generally yielded diagnostic-quality images. The distance from the device generator to the RV lead tip emerged as a critical predictor, with specific thresholds that may guide clinical choices about which CIED patients are suitable for LGE-CMR.

These findings suggest that considering device type and positioning may help identify which patients are suitable for CMR and improve diagnostic accuracy in this population.Figure 1