CMR-Verified Diffuse Myocardial Fibrosis Is Associated With Diastolic Dysfunction in HFpEF

Abstract Objectives The purpose of this study was to investigate diffuse myocardial fibrosis in patients with systolic heart failure (SHF) and in patients with heart failure with preserved ejection fraction (HFpEF) and the association with diastolic dysfunction of the left ventricle (LV). Background...

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Bibliographic Details
Published in:JACC. Cardiovascular imaging 2014-10, Vol.7 (10), p.991-997
Main Authors: Su, Mao-Yuan M., PhD, Lin, Lian-Yu, MD, PhD, Tseng, Yao-Hui E., MD, Chang, Chin-Chen, MD, Wu, Cho-Kai, MD, Lin, Jiunn-Lee, MD, PhD, Tseng, Wen-Yih I., MD, PhD
Format: Article
Language:English
Subjects:
Aged
Cardiovascular
Female
Fibrosis
Heart Failure, Systolic - complications
Heart Failure, Systolic - diagnostic imaging
Heart Failure, Systolic - pathology
Heart Failure, Systolic - physiopathology
Humans
Image Processing, Computer-Assisted
Magnetic Resonance Imaging - methods
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Myocardium - pathology
Stroke Volume - physiology
Ultrasonography
Ventricular Dysfunction, Left - complications
Ventricular Dysfunction, Left - pathology
Ventricular Dysfunction, Left - physiopathology
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Summary:Abstract Objectives The purpose of this study was to investigate diffuse myocardial fibrosis in patients with systolic heart failure (SHF) and in patients with heart failure with preserved ejection fraction (HFpEF) and the association with diastolic dysfunction of the left ventricle (LV). Background Increased diffuse myocardial fibrosis may impair LV diastolic function. However, no study has verified the association between the degree of diffuse myocardial fibrosis and the severity of impaired diastolic function in SHF and HFpEF. Methods Forty patients with SHF, 62 patients with HFpEF, and 22 patients without HF underwent cardiac magnetic resonance (CMR), including T1 mapping and cine CMR on a 3-T system. Extracellular volume fraction (ECV), a measure of diffuse myocardial fibrosis, was quantified from T1 mapping. Systolic and diastolic functions of the LV were assessed by cine CMR. The ECV values and LV functional indexes were compared among the 3 groups. Associations between ECV and LV diastolic function were also investigated. Results Compared with patients without HF, significantly higher ECV was found in patients with SHF (31.2% [interquartile range (IQR): 29.0% to 34.1%] vs. 27.9% [IQR: 26.2% to 29.4%], p < 0.001) and HFpEF (28.9% [IQR: 27.8% to 31.3%] vs. 27.9% [IQR: 26.2% to 29.4%], p = 0.006). Peak filling rate, a diastolic functional index assessed by cine CMR, was significantly decreased in patients with SHF (1.00 s−1 [IQR: 0.79 to 1.49 s−1 ] vs. 3.86 s−1 [IQR: 3.34 to 4.48 s−1 ], p 
ISSN:1936-878X
1876-7591
DOI:10.1016/j.jcmg.2014.04.022