Interstitial Fibrosis, Functional Status, and Outcomes in Heart Failure With Preserved Ejection Fraction: Insights From a Prospective Cardiac Magnetic Resonance Imaging Study
| Autor: | Caroline Zotter-Tufaro, Stefan Aschauer, Diana Bonderman, Marianne L. Schwaiger, Andreas A. Kammerlander, Beatrice A. Marzluf, Franz Duca, Julia Mascherbauer |
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| Předmět: |
Male
medicine.medical_specialty Biopsy Health Status Kaplan-Meier Estimate 030204 cardiovascular system & hematology Interstitial fibrosis Coronary Angiography Severity of Illness Index Disease-Free Survival Ventricular Function Left 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Cardiac magnetic resonance imaging Predictive Value of Tests Risk Factors Internal medicine Extracellular fluid medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Aged Proportional Hazards Models Aged 80 and over Heart Failure Chi-Square Distribution medicine.diagnostic_test Ventricular Remodeling business.industry Myocardium Reproducibility of Results Magnetic resonance imaging Stroke Volume medicine.disease Fibrosis Magnetic Resonance Imaging Echocardiography Doppler Heart failure Austria Multivariate Analysis Cardiology Functional status Female Cardiology and Cardiovascular Medicine Heart failure with preserved ejection fraction business |
| Zdroj: | Scopus-Elsevier |
| Popis: | Background— Myocardial extracellular volume (ECV) accumulation is one of the key pathophysiologic features of heart failure with preserved ejection fraction (HFpEF). Our aims were to (1) measure ECV by cardiac magnetic resonance T1 mapping using the modified Look-Locker inversion recovery (MOLLI) sequence, (2) validate MOLLI-ECV against histology, and (3) investigate the relationship between MOLLI-ECV and prognosis in HFpEF. Methods and Results— One-hundred seventeen consecutive HFpEF patients underwent cardiac magnetic resonance imaging, coronary angiography, and invasive hemodynamic assessments at baseline. Eighteen patients also underwent left ventricular biopsy for histological analysis (Histo-ECV). To assess the prognostic impact of MOLLI-ECV, its association with hospitalization for heart failure/cardiac death was tested by multivariable Cox regression analysis. Histo-ECV was 30.1±4.6% and was significantly correlated with MOLLI-ECV ( R =0.494, P =0.037). Patients were followed for 24.0 months (6.0–32.0 months), during which 34 had a cardiac event. By Kaplan–Meier analysis, patients with MOLLI-ECV ≥ the median (28.9%) had shorter event-free survival (log-rank, P =0.028). MOLLI-ECV significantly correlated with N-terminal prohormone of brain natriuretic peptide ( P P =0.004), New York Heart Association functional class ( P =0.009), right atrial pressure ( P =0.037), and stroke volume ( P =0.043). By multivariable Cox regression analysis, MOLLI-ECV was associated with outcome among imaging variables ( P =0.038) but not after adjustment for clinical and invasive hemodynamic parameters. Conclusions— We demonstrate that MOLLI-ECV in HFpEF accurately reflects histological ECV, correlates with markers of disease severity, and is associated with outcome among cardiac magnetic resonance parameters but not after adjustment for important clinical and invasive hemodynamic parameters. Nevertheless, MOLLI-ECV has the potential of becoming an important biomarker in HFpEF. |
| Databáze: | OpenAIRE |
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