Interstitial Fibrosis, Functional Status, and Outcomes in Heart Failure With Preserved Ejection Fraction: Insights From a Prospective Cardiac Magnetic Resonance Imaging Study
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)...
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| Veröffentlicht in: | Circulation. Cardiovascular imaging 2016-12, Vol.9 (12) |
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| creator | Duca, Franz Kammerlander, Andreas A Zotter-Tufaro, Caroline Aschauer, Stefan Schwaiger, Marianne L Marzluf, Beatrice A Bonderman, Diana Mascherbauer, Julia |
| description | 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.
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 |
| doi_str_mv | 10.1161/CIRCIMAGING.116.005277 |
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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<0.001), 6-minute walk distance (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.
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.</description><identifier>ISSN: 1941-9651</identifier><identifier>EISSN: 1942-0080</identifier><identifier>DOI: 10.1161/CIRCIMAGING.116.005277</identifier><identifier>PMID: 27974408</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Aged, 80 and over ; Austria ; Biopsy ; Chi-Square Distribution ; Coronary Angiography ; Disease-Free Survival ; Echocardiography, Doppler ; Female ; Fibrosis ; Health Status ; Heart Failure - diagnostic imaging ; Heart Failure - mortality ; Heart Failure - pathology ; Heart Failure - physiopathology ; Humans ; Kaplan-Meier Estimate ; Magnetic Resonance Imaging ; Male ; Multivariate Analysis ; Myocardium - pathology ; Predictive Value of Tests ; Proportional Hazards Models ; Prospective Studies ; Reproducibility of Results ; Risk Factors ; Severity of Illness Index ; Stroke Volume ; Ventricular Function, Left ; Ventricular Remodeling</subject><ispartof>Circulation. Cardiovascular imaging, 2016-12, Vol.9 (12)</ispartof><rights>2016 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c258t-63f5c36e250965b3ec3f8a88ccc01c4b0c0a801288d062652e0e9d102de47fe93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27974408$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Duca, Franz</creatorcontrib><creatorcontrib>Kammerlander, Andreas A</creatorcontrib><creatorcontrib>Zotter-Tufaro, Caroline</creatorcontrib><creatorcontrib>Aschauer, Stefan</creatorcontrib><creatorcontrib>Schwaiger, Marianne L</creatorcontrib><creatorcontrib>Marzluf, Beatrice A</creatorcontrib><creatorcontrib>Bonderman, Diana</creatorcontrib><creatorcontrib>Mascherbauer, Julia</creatorcontrib><title>Interstitial Fibrosis, Functional Status, and Outcomes in Heart Failure With Preserved Ejection Fraction: Insights From a Prospective Cardiac Magnetic Resonance Imaging Study</title><title>Circulation. Cardiovascular imaging</title><addtitle>Circ Cardiovasc Imaging</addtitle><description>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.
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<0.001), 6-minute walk distance (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.
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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Austria</subject><subject>Biopsy</subject><subject>Chi-Square Distribution</subject><subject>Coronary Angiography</subject><subject>Disease-Free Survival</subject><subject>Echocardiography, Doppler</subject><subject>Female</subject><subject>Fibrosis</subject><subject>Health Status</subject><subject>Heart Failure - diagnostic imaging</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - pathology</subject><subject>Heart Failure - physiopathology</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Myocardium - pathology</subject><subject>Predictive Value of Tests</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Stroke Volume</subject><subject>Ventricular Function, Left</subject><subject>Ventricular Remodeling</subject><issn>1941-9651</issn><issn>1942-0080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkd1u1DAQhS0EoqXwCpUvuSBl7MSOw10VNdtILUUFxGXkdSZbV4mz2E6lvlSfEe9uqXo1o0_nzI8OIacMzhiT7Gvd3tbt9fmq_b7agTMAwcvyDTlmVcEzAAVv9z3LKinYEfkQwj2AzEGo9-SIl1VZFKCOyVPrIvoQbbR6pI1d-znY8IU2izPRzi7Bn1HHJSHtenqzRDNPGKh19BK1j7TRdlw80j823tEfHgP6B-zpxT3u_bTxet98o60LdnMXQ0LzRHUSz2G7Uz0grbXvrTb0Wm8cRmvoLYa03Bmk7aQ31m3SGUv_-JG8G_QY8NNzPSG_m4tf9WV2dbNq6_OrzHChYibzQZhcIheQ3l_naPJBaaWMMcBMsQYDWgHjSvUguRQcAaueAe-xKAes8hPy-TB36-e_C4bYTTYYHEftcF5Cx5TgUgmVF0kqD1KT_gkeh27r7aT9Y8eg22XVvcpqB7pDVsl4-rxjWU_Yv9j-h5P_A7x0k5A</recordid><startdate>201612</startdate><enddate>201612</enddate><creator>Duca, Franz</creator><creator>Kammerlander, Andreas A</creator><creator>Zotter-Tufaro, Caroline</creator><creator>Aschauer, Stefan</creator><creator>Schwaiger, Marianne L</creator><creator>Marzluf, Beatrice A</creator><creator>Bonderman, Diana</creator><creator>Mascherbauer, Julia</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201612</creationdate><title>Interstitial Fibrosis, Functional Status, and Outcomes in Heart Failure With Preserved Ejection Fraction: Insights From a Prospective Cardiac Magnetic Resonance Imaging Study</title><author>Duca, Franz ; Kammerlander, Andreas A ; Zotter-Tufaro, Caroline ; Aschauer, Stefan ; Schwaiger, Marianne L ; Marzluf, Beatrice A ; Bonderman, Diana ; Mascherbauer, Julia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c258t-63f5c36e250965b3ec3f8a88ccc01c4b0c0a801288d062652e0e9d102de47fe93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Austria</topic><topic>Biopsy</topic><topic>Chi-Square Distribution</topic><topic>Coronary Angiography</topic><topic>Disease-Free Survival</topic><topic>Echocardiography, Doppler</topic><topic>Female</topic><topic>Fibrosis</topic><topic>Health Status</topic><topic>Heart Failure - diagnostic imaging</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - pathology</topic><topic>Heart Failure - physiopathology</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Myocardium - pathology</topic><topic>Predictive Value of Tests</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Reproducibility of Results</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Stroke Volume</topic><topic>Ventricular Function, Left</topic><topic>Ventricular Remodeling</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Duca, Franz</creatorcontrib><creatorcontrib>Kammerlander, Andreas A</creatorcontrib><creatorcontrib>Zotter-Tufaro, Caroline</creatorcontrib><creatorcontrib>Aschauer, Stefan</creatorcontrib><creatorcontrib>Schwaiger, Marianne L</creatorcontrib><creatorcontrib>Marzluf, Beatrice A</creatorcontrib><creatorcontrib>Bonderman, Diana</creatorcontrib><creatorcontrib>Mascherbauer, Julia</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation. Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Duca, Franz</au><au>Kammerlander, Andreas A</au><au>Zotter-Tufaro, Caroline</au><au>Aschauer, Stefan</au><au>Schwaiger, Marianne L</au><au>Marzluf, Beatrice A</au><au>Bonderman, Diana</au><au>Mascherbauer, Julia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Interstitial Fibrosis, Functional Status, and Outcomes in Heart Failure With Preserved Ejection Fraction: Insights From a Prospective Cardiac Magnetic Resonance Imaging Study</atitle><jtitle>Circulation. Cardiovascular imaging</jtitle><addtitle>Circ Cardiovasc Imaging</addtitle><date>2016-12</date><risdate>2016</risdate><volume>9</volume><issue>12</issue><issn>1941-9651</issn><eissn>1942-0080</eissn><abstract>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.
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<0.001), 6-minute walk distance (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.
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.</abstract><cop>United States</cop><pmid>27974408</pmid><doi>10.1161/CIRCIMAGING.116.005277</doi></addata></record> |
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| subjects | Aged Aged, 80 and over Austria Biopsy Chi-Square Distribution Coronary Angiography Disease-Free Survival Echocardiography, Doppler Female Fibrosis Health Status Heart Failure - diagnostic imaging Heart Failure - mortality Heart Failure - pathology Heart Failure - physiopathology Humans Kaplan-Meier Estimate Magnetic Resonance Imaging Male Multivariate Analysis Myocardium - pathology Predictive Value of Tests Proportional Hazards Models Prospective Studies Reproducibility of Results Risk Factors Severity of Illness Index Stroke Volume Ventricular Function, Left Ventricular Remodeling |
| title | Interstitial Fibrosis, Functional Status, and Outcomes in Heart Failure With Preserved Ejection Fraction: Insights From a Prospective Cardiac Magnetic Resonance Imaging Study |
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