Magnetic Resonance Imaging in Detection and Functional Assessment of Coronary Artery Disease

Current Atherosclerosis Reports. Mar, 2002  |  Pubmed ID: 11822976

The past few years have brought significant improvements in the field of cardiovascular magnetic resonance imaging (MRI), which evolved from an experimental technique to a clinically accepted method of coronary artery disease detection (stress MRI) and viability assessment. In this article, we describe current MRI technology for detection and functional assessment of ischemia, such as dobutamine/atropine MRI, perfusion techniques, viability, and flow reserve in native coronary arteries and grafts. With further refinement in the technology, wide acceptance of cardiovascular MRI is anticipated in clinical practice.

Glycoprotein IIb-IIIa Inhibition with Abciximab and Postprocedural Risk Assessment: Lessons from the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting Trial and Implication for Ad Hoc Use of Glycoprotein IIb-IIIa Antagonists

American Heart Journal. Apr, 2002  |  Pubmed ID: 11923795

Angiographic features of vessels in which stents have been deployed can be used to predict the risk of postprocedural ischemic events. The purpose of this study was to compare the effects of abciximab in patients with and without high-risk postprocedure features.

Prognostic Value of Exercise Echocardiography: Validation of a New Risk Index Combining Echocardiographic, Treadmill, and Exercise Electrocardiographic Parameters

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. Apr, 2003  |  Pubmed ID: 12712013

Exercise (Ex) echocardiography has been shown to have significant prognostic power, independent of other known predictors of risk from an Ex stress test. The purpose of this study was to evaluate a risk index, incorporating echocardiographic and conventional Ex variables, for a more comprehensive risk stratification and identification of a very low-risk group. Two consecutive, mutually exclusive populations referred for treadmill Ex echocardiography with the Bruce protocol were investigated: hypothesis-generating (388 patients; 268 males; age 55 +/- 13 years) and hypothesis-testing (105 patients; 61 males age: 54 +/- 14 years).Cardiac events included cardiac death, myocardial infarction, late revascularization (>90 days), hospital admission for unstable angina, and admission for heart failure. Mean follow-up in the hypothesis-generating population was 3.1 years. There were 38 cardiac events. Independent predictors of events by multivariate analysis were: Ex wall motion score index (odds ratio [OR] = 2.77/Unit; P <.001); ischemic S-T depression > or = 1 mm (OR = 2.84; P =.002); and treadmill time (OR = 0.87/min; P =.037). A risk index was generated on the basis of the multivariate Cox regression model as: risk index = 1.02 (Ex wall motion score index) + 1.04 (S-T change) - 0.14 (treadmill time). The validity of this index was tested in the hypothesis-testing population. Event rates at 3 years were lowest (0%) in the lower quartile of risk index (-1.22 to -0.47), highest (29.6%) in the upper quartile (+0.66 to +2.02), and intermediate (19.2% to 15.3%) in the intermediate quartiles. The OR of the risk index for predicting cardiac events was 2.94/Unit ([95% confidence interval: 1.4 to 6.2]; P =.0043). Echocardiographic and Ex parameters are independent powerful predictors of cardiac events after treadmill stress testing. A risk index can be derived with these parameters for a more comprehensive risk stratification with Ex echocardiography.

Detection of Pseudoaneurysm of the Left Ventricle by Fast Imaging Employing Steady-state Acquisition (FIESTA) Magnetic Resonance Imaging

Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance. 2003  |  Pubmed ID: 12765118

This report highlights the importance of interpretating images throughout the course of a dobutamine MRI stress test. Upon review of the baseline images, the left ventricular (LV) endocardium was not well seen due to flow artifacts associated with low intracavitary blood-flow velocity resulting from a prior myocardial infarction. Physicians implemented a cine fast imaging employing steady-state acquisition (FIESTA) technique that was not subject to low flow artifact within the LV cavity. With heightened image clarity, physicians unexpectedly identified a LV pseudoaneurysm.

Assessment of Cardiac Function with MR Imaging

Magnetic Resonance Imaging Clinics of North America. Feb, 2003  |  Pubmed ID: 12797511

A variety of black or white blood imaging techniques are available for assessing global and regional LV and RV function during cardiovascular MR imaging examinations. In addition to providing information about LV function at rest, these techniques provide diagnostic and prognostic information regarding myocardial ischemia and viability during MR imaging stress tests.

Feasibility to Detect Severe Coronary Artery Stenoses with Upright Treadmill Exercise Magnetic Resonance Imaging

The American Journal of Cardiology. Sep, 2003  |  Pubmed ID: 12943887

We performed treadmill exercise magnetic resonance imaging in 27 patients with exertional chest pain who were referred for contrast coronary angiography to determine the feasibility of this method to identify severe coronary artery stenoses. The sensitivity and specificity for detecting >70% coronary artery luminal diameter narrowings on contrast coronary angiography were 79% and 85%, respectively.

Myocardial Infarction. Coronary Calcium and C-reactive Protein: Another Tip of the Iceberg

Reviews in Cardiovascular Medicine. 2003  |  Pubmed ID: 12949449

Atherosclerosis. Bigger is Better: High-density and Low-density Lipoprotein Particle Size

Reviews in Cardiovascular Medicine. 2005  |  Pubmed ID: 15976735

Anterior Mitral Valve Leaflet Aneurysm Due to Infective Endocarditis Detected by Cardiac Magnetic Resonance Imaging

Reviews in Cardiovascular Medicine. 2006  |  Pubmed ID: 17088861

We report a case of mitral valve aneurysm in a 30-year-old man presenting with fatigue, malaise, and fever 10 weeks after emergent aortic valve replacement for endocarditis. The transthoracic echocardiogram demonstrated perivalvular aortic regurgitation, but no abscess cavity was defined. Cardiac magnetic resonance imaging (MRI) revealed a mitral valve leaflet aneurysm. Both aortic and mitral valves were replaced with mechanical prostheses. Pathology of the excised mitral valve showed a focally hemorrhagic aneurysm of the anterior leaflet with myxoid degeneration and focal calcification. Early diagnosis and intervention are important to treat this rare, potentially fatal complication of aortic valve endocarditis. Cardiac MRI provided an accurate and useful preoperative diagnostic evaluation.

Large Mitral Annular Left Ventricular Pseudoaneurysm Detected by Cardiac Magnetic Resonance Imaging

The Journal of Invasive Cardiology. Feb, 2007  |  Pubmed ID: 17268044

Although left ventricular pseudoaneurysm (LVPA) is a rare complication of mitral valve replacement, it is associated with an increased risk of rupture and consequent high mortality. It is important to establish the diagnosis of LVPA early so that definitive surgical therapy can be administered. Cardiac magnetic resonance imaging provides an accurate preoperative evaluation that may be useful in the routine evaluation of suspected LVPA cases.

Feasibility of Biventricular Pacing in Patients with Recent Myocardial Infarction: Impact on Ventricular Remodeling

Congestive Heart Failure (Greenwich, Conn.). Jan-Feb, 2007  |  Pubmed ID: 17268205

To test the hypothesis that biventricular pacing after a myocardial infarction with reduced ejection fraction can attenuate left ventricular (LV) remodeling, the authors studied 18 patients (myocardial infarction within 30-45 days, ejection fraction

Comparison of Ultrafiltration, Nesiritide, and Usual Care in Acute Decompensated Heart Failure

Congestive Heart Failure (Greenwich, Conn.). Nov-Dec, 2008  |  Pubmed ID: 19076851

To study the short-term effects of initial treatment strategies for acute decompensated heart failure, 25 patients treated with ultrafiltration (UF) were retrospectively compared with 25 patients treated with usual care (UC) and 25 patients treated with UC plus adjunctive nesiritide infusion (UN), matched for age, sex, ejection fraction, etiology, and serum creatinine. The median length of hospitalization was 6 days for UF, 4 days for UC, and 6 days for UN. All-cause 30-day readmissions tended to be fewer in the UF (16%) compared with the UN (24%) or UC (24%) groups. All groups lost weight, although to a greater extent in the UF group (15.8 lb vs 6.3 lb in UC and 4.7 lb in UN). Concomitantly, UF manifested the greatest increase in serum urea nitrogen, creatinine, and the number of patients with creatinine increases of >0.5 mg/dL (44% vs 24% in UC and 20% in UN). In acute decompensated heart failure, UF appears to be more effective for volume removal and possibly prevention of all-cause hospital readmission to 30 days than UC or UN. These findings, as well as the effects on renal function and length of stay, need to be further evaluated in a prospective randomized study.

The Role of Echocardiography in Cardiac Resynchronization Therapy

Current Heart Failure Reports. Mar, 2009  |  Pubmed ID: 19265591

Echocardiography is the most important imaging tool for managing heart failure patients. With the advent of cardiac resynchronization therapy (CRT), its role has been broadened by data pertaining to patient selection, optimization of device settings, and outcome assessment. Beyond ejection fraction determination, echocardiographic methods that measure tissue velocity and strain may have the capability to determine degree of mechanical dyssynchrony and possibly predict likelihood of benefit with CRT. After implantation (as the ventricles are fully paced, adjusting the atrioventricular delay ), the timing of the right ventricular and left ventricular lead stimulation (ventricular-ventricular optimization) to achieve maximal cardiac filling or ejection may be clinically important. Atrioventricular and ventricular-ventricular optimization rely on echocardiography to determine optimal values. In long-term follow-up, serial measurement of left ventricular volume has significant correlation with mortality and is a reasonable measure of successful CRT; echocardiography is uniquely suited for this purpose.

Circumferential Strain Analysis Identifies Strata of Cardiomyopathy in Duchenne Muscular Dystrophy: a Cardiac Magnetic Resonance Tagging Study

Journal of the American College of Cardiology. Apr, 2009  |  Pubmed ID: 19341862

This study sought to evaluate the natural history of occult cardiac dysfunction in Duchenne muscular dystrophy (DMD).

Coronary Sinus to Left Atrial Communication

Case Reports in Medicine. 2009  |  Pubmed ID: 19730747

Congenital coronary sinus anomalies are rare in clinical practice, partly due to the lack of symptoms. We present a case of coronary sinus anomaly causing a right-to-left intracardiac shunt in a 46 years/old African American female with a past medical history of obstructive sleep apnea, diabetes mellitus, hypertension, coronary artery disease, and ischemic cardiomyopathy who presented with hypoxia. In the months prior to her presentation, she had suffered an inferior myocardial infarction with right ventricular involvement, as well as resulting severe tricuspid regurgitation. In conclusion, further investigations revealed a communication between the coronary sinus (CS) and left atrium (LA).

The What and Why of Cardiac CT Angiography: Data Interpretation and Clinical Practice Integration

Reviews in Cardiovascular Medicine. 2009  |  Pubmed ID: 19898292

Noninvasive visualization of the coronary arteries is the holy grail of cardiac imaging. Cardiac catheterization, the historic gold standard for coronary imaging, is invasive, costly, and often performed unnecessarily. Cardiac computed tomographic angiography (CCTA) is a widely available, cost-effective imaging modality that effectively images the coronary arteries. The most appropriate patient for a CCTA-guided approach to the evaluation of chest pain is the symptomatic patient at low to intermediate risk. Data are rapidly evolving to further validate the accuracy, prognostic ability, and cost-effectiveness of this technique. The current landscape of the American medical system and the rising cost of United States health care have led to skepticism concerning CCTA and its potential misuse. Technological misunderstanding and concern about excessive radiation exposure also threaten its growth. When used properly by appropriately trained physicians, CCTA adds significant value to the evaluation of chest pain and to the diagnosis of coronary artery disease.

Peri-infarct Pacing with CRT in the Early Postinfarct Phase to Attenuate Long-term Remodeling

Journal of Cardiovascular Translational Research. Mar, 2009  |  Pubmed ID: 20559976

Deleterious left ventricular remodeling routinely occurs after myocardial infarction (MI) and novel strategies to attenuate this phenomenon may prove valuable. Here, we describe the potential role of left ventricular (LV) peri-infarct pacing (delivered via biventricular pacemakers) to reduce post-MI remodeling. Regional wall stress in the infarcted area is predictive of remodeling and therefore represents a potential therapeutic target. Using an intrinsic property of pacing to reduce stress and work at the pacing site, there are animal data to suggest that long-term peri-infarct pacing can have a salutary effect on cardiac structure after MI. This concept was tested in a pilot human study, suggesting attenuation of ventricular dilation in post-MI patients treated with LV pacing compared with control. To further characterize this concept, a 110-patient, multicenter, randomized Prevention of Myocardial Enlargement and Dilatation post-Myocardial Infarction Study (MENDMI) has completed enrollment. Inclusion criteria included anterior MI, QRS < 120 ms, ejection fraction 2,000, and wall motion abnormalities in at least five of 16 segments. MENDMI will help to determine whether chronic application of peri-infarct pacing provides structural and clinical benefits and will help in the design of further investigations to modify postinfarction ventricular remodeling.

Echocardiographic Assessment of Dyssynchrony: Moving Forward

Circulation. Heart Failure. Sep, 2010  |  Pubmed ID: 20841545

Extent of RV Dysfunction and Myocardial Infarction Assessed by CMR Are Independent Outcome Predictors Early After STEMI Treated with Primary Angioplasty

JACC. Cardiovascular Imaging. Dec, 2010  |  Pubmed ID: 21163452

The aim of this study was to assess the prognostic value of right ventricular (RV) involvement diagnosed by cardiac magnetic resonance (CMR) early after ST-elevation myocardial infarction (STEMI).

Comparison of Magnetic Resonance Feature Tracking for Strain Calculation with Harmonic Phase Imaging Analysis

JACC. Cardiovascular Imaging. Feb, 2010  |  Pubmed ID: 20159640

To compare a steady-state free precession cine sequence-based technique (feature tracking [FT]) to tagged harmonic phase (HARP) analysis for peak average circumferential myocardial strain (epsilon(cc)) analysis in a large and heterogeneous population of boys with Duchenne muscular dystrophy (DMD).

Left Ventricular T2 Distribution in Duchenne Muscular Dystrophy

Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance. 2010  |  Pubmed ID: 20298602

Although previous studies have helped define the natural history of Duchenne muscular dystrophy (DMD)-associated cardiomyopathy, the myocardial pathobiology associated with functional impairment in DMD is not yet known.The objective of this study was to assess the distribution of transverse relaxation time (T2) in the left ventricle (LV) of DMD patients, and to determine the association of myocardial T2 heterogeneity to the severity of cardiac dysfunction. DMD patients (n = 26) and normal control subjects (n = 13) were studied by cardiovascular magnetic resonance (CMR). DMD subject data was stratified based on subject age and LV ejection fraction (EF) into the following groups: A (<12 years old, n = 12); B (>or=12 years old, EF or=12 years old, EF = 55%, n = 6). Controls were also stratified by age into Groups N1 (<12 years, n = 6) and N2 (>12 years, n = 5). LV mid-slice circumferential myocardial strain (epsilon cc) was calculated using tagged CMR imaging. T2 maps of the LV were generated for all subjects using a black blood dual spin echo method at two echo times. The full width at half maximum (FWHM) was calculated from a histogram of LV T2 distribution constructed for each subject.

Detection of Progressive Cardiac Dysfunction by Serial Evaluation of Circumferential Strain in Patients with Duchenne Muscular Dystrophy

The American Journal of Cardiology. May, 2010  |  Pubmed ID: 20451693

The present study evaluated progressive cardiac dysfunction using serial circumferential strain (epsilon(cc)) measurements in patients with Duchenne muscular dystrophy (DMD). DMD is characterized by progressive cardiac dysfunction and myocardial fibrosis late in the disease process. We hypothesized that serial epsilon(cc) changes could be detected in individual patients with DMD during a time when the left ventricular ejection fraction (EF) changes are insignificant. Cardiac magnetic resonance imaging data from patients with DMD were evaluated. The left ventricular EF was calculated from steady-state free precession cine images and the composite epsilon(cc) measurement from tagged cine images. The serial epsilon(cc) and EF values for each patient were analyzed using the Wilcoxon sign rank test. Data from 51 patients with DMD (2 studies per patient, mean age at the initial study 11.8 +/- 3.5 years, range 7.4 to 25.4) were analyzed, with a mean interval between cardiac magnetic resonance studies of 15.6 +/- 6.0 months (range 6.2 to 28.1). In the interval between studies, the epsilon(cc) had decreased in all patients with DMD. The average decrease was 1.8 +/- 1.3 (p <0.001). However, the EF had decreased in 33 of the 51 patients and had increased in 18 of the 51 patients. On average, the EF decreased by 2.9 +/- 8.57% (p = NS). In conclusion, in patients with DMD, epsilon(cc) abnormalities indicate progression within a relatively short period when the EF changes were not significant. Serial epsilon(cc) measurements might provide reliable monitoring of the progression of DMD-associated cardiac dysfunction before overt heart failure develops, because it is more sensitive than the EF.

Multimodality Assessment of Cardiac Involvement in Churg-Strauss Syndrome Patients in Clinical Remission

Circulation Journal : Official Journal of the Japanese Circulation Society. 2011  |  Pubmed ID: 21139253

Cardiac involvement in Churg-Strauss syndrome (CSS) is not uncommon, but its frequency varies widely and may depend on the activity of the disease. Therefore, the cardiac involvement in CSS patients in clinical remission was assessed in the present study.

Presence of Mechanical Dyssynchrony in Duchenne Muscular Dystrophy

Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance. 2011  |  Pubmed ID: 21288342

Cardiac dysfunction in boys with Duchenne muscular dystrophy (DMD) is a leading cause of death. Cardiac resynchronization therapy (CRT) has been shown to dramatically decrease mortality in eligible adult population with congestive heart failure. We hypothesized that mechanical dyssynchrony is present in DMD patients and that cardiovascular magnetic resonance (CMR) may predict CRT efficacy.

Diagnostic Performance of Computed Tomography Angiography for Differentiating Ischemic Vs Nonischemic Cardiomyopathy

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology. May, 2011  |  Pubmed ID: 21328027

Although the use of computed tomography angiography (CTA) is considered "appropriate" to distinguish ischemic vs nonischemic etiology in patients with cardiomyopathy under the current clinical practice guideline, the evidence to support this has not been evaluated in larger scale studies. Thus, we conducted a meta-analysis of available studies published by October 2010 to address this question.

The Composition and Extent of Coronary Artery Plaque Detected by Multislice Computed Tomographic Angiography Provides Incremental Prognostic Value in Patients with Suspected Coronary Artery Disease

The International Journal of Cardiovascular Imaging. Mar, 2011  |  Pubmed ID: 21369735

Multislice computed tomographic coronary angiography (CTCA) provides accurate noninvasive assessment of coronary artery disease (CAD). However, data on the prognostic value of CTCA in patients with suspected CAD are only beginning to emerge. The aim of the study was to assess the prognostic value of CTCA in patients with suspected CAD. Patients (males = 259, females = 235; mean age 58.2 ± 9.8 years) with suspected CAD who underwent 16- or 64-slice CTCA were followed for 1,308 ± 318 days for cardiac death, nonfatal myocaridal infarction (MI) and late (>90 days after CTCA) revascularization. Patient outcomes were related to clinical and CTCA data. Cox proportional-hazards model was applied in stepwise forward fashion to identify outcome predictors. Coronary artery plaque was found in 340 patients. Cardiac events occurred in 40 patients including cardiac death (n = 9), nonfatal MI (n = 8) and late revascularization (n = 23). A multivariable analysis identified the following independent predictors for adverse cardiac events: obstructive plaque in a proximal coronary artery segment (hazard ratio (HR) 2.73; 95% confidence interval (CI): 1.35-5.54; P = 0.005), the number of segments with noncalcified plaque(s) (HR 1.53 per segment; 95%CI: 1.21-1.92; P < 0.001), the number of segments with mixed plaque(s) (HR 1.56 per segment; 95%CI: 1.27-1.92; P < 0.001) and the number of segments with calcified plaque(s) (HR 1.21 per segment; 95%CI: 1.07-1.37; P = 0.002). In patients with suspected CAD, both the extent and composition of atherosclerotic plaque as determined by CTCA are prognostic of subsequent cardiac events.

Cardiac Involvement in Wegener's Granulomatosis Resistant to Induction Therapy

European Radiology. Nov, 2011  |  Pubmed ID: 21786089

The aim of the study was to assess cardiac involvement in patients with Wegener's granulomatosis (WG), who failed to achieve remission following >6 months induction therapy for life or organ threatening disease.

Liquefaction Necrosis of Mitral Annular Calcification (LNMAC): Review of Pathology, Prevalence, Imaging and Management: Proposed Diagnostic Imaging Criteria with Detailed Multi-modality and MRI Image Characterization

The International Journal of Cardiovascular Imaging. Aug, 2011  |  Pubmed ID: 21863322

Liquefactive necrosis within a large spheroid zone of mitral annular calcification (LNMAC) is an atypical but increasingly recognized variant of mitral annular calcification (MAC). Proposed MRI, echo, and CT imaging criteria for diagnosis of this unusual disease entity are discussed along with a review of the prognosis, histopathology, and management implications. A comprehensive ECHO, CT, and MRI imaging approach to diagnostic differentiation from other cardiac masses, allowing characterization of the differing components of this unusual lesion is emphasized. Differentiation from surrounding myocardium, and demonstration of peripheral ring type hyperenhancement, or hyperintense signal in the wall of this lesion, seen with specific inversion recovery MRI sequences is presented as a major diagnostic criterion. The relationship of these MRI image findings to underlying pathology is also discussed. An illustrative case vignette is provided for clinical reference.

Effects of Steroids and Angiotensin Converting Enzyme Inhibition on Circumferential Strain in Boys with Duchenne Muscular Dystrophy: a Cross-sectional and Longitudinal Study Utilizing Cardiovascular Magnetic Resonance

Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance. 2011  |  Pubmed ID: 22011358

Steroid use has prolonged ambulation in Duchenne muscular dystrophy (DMD) and combined with advances in respiratory care overall management has improved such that cardiac manifestations have become the major cause of death. Unfortunately, there is no consensus for DMD-associated cardiac disease management. Our purpose was to assess effects of steroid use alone or in combination with angiotensin converting enzyme inhibitors (ACEI) or angiotension receptor blocker (ARB) on cardiovascular magnetic resonance (CMR) derived circumferential strain (εcc).

Algorithm-based Assessment of Target Weight Removal in Acute Decompensated Heart Failure

Congestive Heart Failure (Greenwich, Conn.). Jan, 2012  |  Pubmed ID: 22277177

Acute decompensated heart failure (ADHF) remains a leading cause of hospitalization. The majority of these patients are admitted for volume overload, with fluid removal as the main therapeutic target. Practice guidelines do not appoint methods for determining the amount of volume that should be removed. The authors hypothesize that rigorous, protocol-driven establishment of a target weight to be removed would enhance actual volume removal and short-term outcomes. Forty-seven patients admitted with ADHF were enrolled. Each patient had target weight removal (TWR) determined by a heart failure (HF) specialist (serving as the gold standard). Separately, a nurse practitioner calculated the TWR from an algorithm using: (1) baseline weight, (2) renal function, and (3) degree of lower extremity edema. There was good correlation of TWR from an algorithmic approach compared with expert determination (r(2) =0.8). A total of 87% of patients reached a discharge weight within 20% of the TWR. A more standardized approach to estimating target weight loss for hospitalized HF patients approximates those of HF specialists. Furthermore, this algorithm could be utilized by general practitioners in settings where an HF specialist is not readily available. Congest Heart Fail. 2012;18:43-46. ©2011 Wiley Periodicals, Inc.

Patterns of Left Ventricular Remodeling in Patients with Duchenne Muscular Dystrophy: a Cardiac MRI Study of Ventricular Geometry, Global Function, and Strain

The International Journal of Cardiovascular Imaging. Jan, 2012  |  Pubmed ID: 21222036

The cardiac disease ubiquitously associated in Duchenne Muscular Dystrophy (DMD) has traditionally been considered a progressive dilated cardiomyopathy (DCM). However, left ventricular (LV) dilatation as measured with cardiac MRI has not been a consistent finding in this population, even as circumferential strain (ε(cc)) declines with advancing disease. We hypothesized that a distinct pattern of changes in LV geometry, during the course of ε(cc) decline, distinguishes DMD associated heart disease from DCM. Using CMR, LV end-diastolic volume (EDV), mass (LVM), ejection fraction, ε(cc) and myocardial delayed enhancement (MDE) were determined in DMD patients and normal control subjects. The LV Remodeling Index (LVRI) was calculated as the ratio of LV Mass to Volume (LVM/EDV). Statistical comparisons between all LV parameters and genotype were also performed. Median LVRI in DMD (n = 127) and control subjects (n = 41) were different (0.75 vs. 0.65, P = 0.0150) but within normal range. Furthermore, the median LVRI in DMD boys with reduced LV systolic function was significantly reduced compared to those with normal LV systolic function (0.64 vs. 0.75, P = 0.0974). However, the presence of MDE was associated with a lower median LVRI (0.57 vs. 0.76, P = 0.0471). Regression analysis showed no significant correlation between ε(cc) and LVRI (r = -0.03). The LVRI of DMD patients is unexpectedly normal and not correlated with ε(cc.) Based on these findings, DMD-associated heart disease exhibits a unique remodeling pattern distinct from DCM.