Association between extracellular matrix expansion quantified by cardiovascular magnetic resonance and short-term mortality
| Autor: | Peter Kellman, Kayla Piehler, Suresh Mulukutla, Timothy C. Wong, Christopher G Meier, Stephen M Testa, Marc A. Simon, David Schwartzman, Erik B. Schelbert, Amanda M. Klock, Jonathan Shakesprere, Ali A. Aneizi, Sanjeev G. Shroff |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
collagen
Male Pathology Gadolinium Comorbidity Cardiorespiratory Medicine and Haematology Cardiovascular Extracellular matrix Models Fibrosis Risk Factors magnetic resonance imaging Myocardial infarction screening and diagnosis medicine.diagnostic_test Ventricular Remodeling Hypertrophic cardiomyopathy Models Cardiovascular Middle Aged Prognosis Magnetic Resonance Imaging Extracellular Matrix Detection Heart Disease Public Health and Health Services Cardiology Female Cardiology and Cardiovascular Medicine Adult medicine.medical_specialty Heart Diseases Clinical Sciences Article Young Adult Clinical Research Predictive Value of Tests Physiology (medical) Internal medicine medicine Extracellular Humans Ventricular remodeling Heart Disease - Coronary Heart Disease Aged Proportional Hazards Models business.industry Myocardium Magnetic resonance imaging medicine.disease mortality 4.1 Discovery and preclinical testing of markers and technologies Cardiac Imaging Techniques Good Health and Well Being Cardiovascular System & Hematology myocardial fibrosis Myocardial fibrosis business |
| Zdroj: | Circulation, vol 126, iss 10 |
| ISSN: | 1524-4539 |
| Popis: | Background— Extracellular matrix expansion may be a fundamental feature of adverse myocardial remodeling, it appears to be treatable, and its measurement may improve risk stratification. Yet, the relationship between mortality and extracellular matrix is not clear because of difficulties with its measurement. To assess its relationship with outcomes, we used novel, validated cardiovascular magnetic resonance techniques to quantify the full spectrum of extracellular matrix expansion not readily detectable by conventional cardiovascular magnetic resonance. Methods and Results— We recruited 793 consecutive patients at the time of cardiovascular magnetic resonance without amyloidosis or hypertrophic cardiomyopathy as well as 9 healthy volunteers (ages 20–50 years). We measured the extracellular volume fraction (ECV) to quantify the extracellular matrix expansion in myocardium without myocardial infarction. ECV uses gadolinium contrast as an extracellular space marker based on T1 measures of blood and myocardium pre— and post–gadolinium contrast and hematocrit measurement. In volunteers, ECV ranged from 21.7% to 26.2%, but in patients it ranged from 21.0% to 45.8%, indicating considerable burden. There were 39 deaths over a median follow-up of 0.8 years (interquartile range 0.5–1.2 years), and 43 individuals who experienced the composite end point of death/cardiac transplant/left ventricular assist device implantation. In Cox regression models, ECV related to all-cause mortality and the composite end point (hazard ratio, 1.55; 95% confidence interval, 1.27–1.88 and hazard ratio, 1.48; 95% confidence interval, 1.23–1.78, respectively, for every 3% increase in ECV), adjusting for age, left ventricular ejection fraction, and myocardial infarction size. Conclusions— ECV measures of extracellular matrix expansion may predict mortality as well as other composite end points (death/cardiac transplant/left ventricular assist device implantation). |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|