The role of late gadolinium enhancement cardiovascular magnetic resonance in the assessment of congenital and acquired heart disease

Cardiovascular magnetic resonance imaging (CMR) has become a cornerstone in the diagnosis and management of congenital heart disease and selected paediatric cardiology patients. This article reviews the relevance of late gadolinium enhancement (LGE) CMR in both congenital and acquired heart diseases. Commonly, adult LGE CMR is with a view to understanding myocardial viability in older ischaemic heart disease patients, where the extent, location, pattern and transmurality of LGE relate to longer term outcomes. However, LGE findings also contribute to diagnosing non-ischaemic cardiomyopathies and their potential aetiology. New uses also include using LGE CMR as an outcome measure in the assessment of interventions including pharmacotherapies. With time there is emerging data regarding a potential role for LGE CMR in risk stratification for arrhythmia and sudden cardiac death. There is therefore understandable interest in its relevance from clinicians involved in assessing and caring for cardiovascular disease in the young, whether congenital or acquired and early reports in these settings are discussed. After outlining aspects concerning principle, practice and pitfalls of the technique, the described clinical experience of late gadolinium enhancement will be discussed. Robust research will be required to fully understand where LGE CMR will fit in with routine clinical paediatric cardiology and adult congenital practice but it seems likely to have a unique role to improve diagnosis and management strategies, determine response to therapies, and assess long term prognosis, not only in ischaemic heart disease patients, but in these cardiac patients too.