Myocardial Fibrosis Quantified by Extracellular Volume Is Associated With Subsequent Hospitalization for Heart Failure, Death, or Both Across the Spectrum of Ejection Fraction and Heart Failure Stage.

Autor: Schelbert EB; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (E.B.S., K.M.Z., C.C.H.C., T.C.W.) UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA (E.B.S., K.M.P., K.M.Z., T.C.W.) Clinical and Translational Science Institute, University of Pittsburgh, PA (E.B.S., T.C.W.)., Piehler KM; UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA (E.B.S., K.M.P., K.M.Z., T.C.W.)., Zareba KM; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (E.B.S., K.M.Z., C.C.H.C., T.C.W.) UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA (E.B.S., K.M.P., K.M.Z., T.C.W.) Department of Medicine, The Ohio State University, Columbus, OH (K.M.Z.)., Moon JC; Barts Heart Centre and University College London, London, UK (J.C.M.)., Ugander M; Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (M.U.)., Messroghli DR; Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (D.R.M.)., Valeti US; Cardiology Division, University of Minnesota, Minneapolis, MN (U.S.V.)., Chang CC; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (E.B.S., K.M.Z., C.C.H.C., T.C.W.) Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (C.C.H.C.)., Shroff SG; Department of Bioengineering, University of Pittsburgh, PA (S.G.S.)., Diez J; Program of Cardiovascular Diseases, Center for Applied Medical Research and University Clinic of Navarra, Pamplona, Spain (J.D.)., Miller CA; Centre for Imaging Sciences and Biomedical Imaging Institute, University of Manchester, UK (C.A.M., M.S.)., Schmitt M; Centre for Imaging Sciences and Biomedical Imaging Institute, University of Manchester, UK (C.A.M., M.S.)., Kellman P; National Heart, Lung, and Blood Institute, Bethesda, MD (P.K.)., Butler J; Cardiology Division, Stony Brook University, Stony Brook, NY (J.B.)., Gheorghiade M; Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (M.G.)., Wong TC; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (E.B.S., K.M.Z., C.C.H.C., T.C.W.) UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA (E.B.S., K.M.P., K.M.Z., T.C.W.) Clinical and Translational Science Institute, University of Pittsburgh, PA (E.B.S., T.C.W.).
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2015 Dec 18; Vol. 4 (12). Date of Electronic Publication: 2015 Dec 18.
DOI: 10.1161/JAHA.115.002613
Abstrakt: Background: Myocardial fibrosis (MF) in noninfarcted myocardium may be an interstitial disease pathway that confers vulnerability to hospitalization for heart failure, death, or both across the spectrum of heart failure and ejection fraction. Hospitalization for heart failure is an epidemic that is difficult to predict and prevent and requires potential therapeutic targets associated with outcomes.
Method and Results: We quantified MF with cardiovascular magnetic resonance extracellular volume fraction (ECV) measures in 1172 consecutive patients without amyloidosis or hypertrophic or stress cardiomyopathy and assessed associations with outcomes using Cox regression. ECV ranged from 16.6% to 47.8%. Over a median of 1.7 years, 111 patients experienced events after cardiovascular magnetic resonance, 55 had hospitalization for heart failure events, and there were 74 deaths. ECV was more strongly associated with outcomes than "nonischemic" MF observed with late gadolinium enhancement, thus ECV quantified MF in multivariable models. Adjusting for age, sex, renal function, myocardial infarction size, ejection fraction, hospitalization status, and heart failure stage, higher ECV was associated with hospitalization for heart failure (hazard ratio 1.77; 95% CI 1.32 to 2.36 for every 5% increase in ECV), death (hazard ratio 1.87 95% CI 1.45 to 2.40) or both (hazard ratio 1.85, 95% CI 1.50 to 2.27). ECV improved classification of persons at risk and improved model discrimination for outcomes (eg, hospitalization for heart failure: continuous net reclassification improvement 0.33, 95% CI 0.05 to 0.66; P=0.02; 0.16, 95% CI 0.01 to 0.33; P=0.02; integrated discrimination improvement 0.037, 95% CI 0.008 to 0.073; P<0.01).
Conclusion: MF measured by ECV is associated with hospitalization for heart failure, death, or both. MF may represent a principal phenotype of cardiac vulnerability that improves risk stratification. Because MF can be reversible, cells and enzymes regulating collagen could be potential therapeutic targets.
(© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
Databáze: MEDLINE
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