86 Chapter 6 Table 3 imaging echo, CT and MRI** Surgery(20) CRT + Surgery(20) p value age corr CAC score (CT scan) 735 (249) 350 (173) 0.20 ns Left atrium Volume Index(LAVI ml/m2) 35.1 (3.6) 30.1 (2.5) ns ns Number of patients with MRI 20 18 Intramural contrast enhancement(LGE) 1 4 0.12 0.13 Mean ECV * 24.0 (0.3) 28.4 (0.3) <0.01 <0.01 Septum thickness(mm) 9.9 (0.4) 8.7 (0.4) 0.04 0.14 *Only eligible results(n=27), **standard error of the mean between brackets A linear pattern of cardiac late gadolinium enhancement (LGE) which is considered a sign of local non ischemic fibrosis [30] was observed in 4 out of 18 irradiated patients vs. in 1 out of 20 non-irradiated patients (Figure 1, p=0.13). Within the nCRT group, the mean radiation dose to the heart (MHD) was significantly higher (26.6 vs. 21.8 Gy, p=0.01) in patients showing linear LGE. T1 mapping was performed in these patients[31]. Mean extracellular volume (ECV) value is an objective quantitative measurement of myocardial fibrosis of the left ventricle, and was calculated by using both the T1 native and the T1 post contrast map[27]. In multilevel analysis, myocardial segments showing this linear LGE (10 vs 262) indeed showed higher ECV values (p=0.01), received a higher radiation dose (p=0.03) and these patients had higher hs-TNT (p=0.03) values. Figure 1 linear late gadolineum enhancement, a sign of non ischaemic fibrosis
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