Relationship of Myocardial Fibrosis to Left Ventricular and Mitochondrial Function in Nonischemic Dilated Cardiomyopathy—A Comparison of Focal and Interstitial Fibrosis

Yamada, Takashi; Hirashiki, Akihiro; Cheng, Xian Wu; Okumura, Takahiro; Shimazu, Shuzo; Okamoto, Rie; Shinoda, Norihiro; Isobe, Satoshi; Takeshita, Kyosuke; Naganawa, Shinji; Kondo, Takahisa; Murohara, Toyoaki

doi:10.1016/j.cardfail.2013.05.018

Cited by 8 publications

(8 citation statements)

References 40 publications

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“…We and others have also previously examined the relationship between LGE and the transcardiac release of troponin T, and the relationship between LGE volume with LVEDP and transcardiac secretion of B-type natriuretic peptide (BNP) in patients with non-ischemic HF [36, 37]. Pulmonary capillary wedge pressure (PCWP), LVEDP and BNP reflect the extent of cardiac wall tension.…”

Section: Discussionmentioning

confidence: 99%

Late gadolinium enhancement on cardiac magnetic resonance predicts coronary vasomotor abnormality and myocardial lactate production in patients with chronic heart failure

et al. 2016

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Myocardial fibrosis and microvascular dysfunction are key determinants of outcome in heart failure (HF); we examined their relationship in patients with HF. Our study included 61 consecutive patients with HF but without coronary stenosis. All underwent gadolinium-enhanced cardiac magnetic resonance to evaluate late gadolinium enhancement (LGE) and an acetylcholine (ACh) provocation test to evaluate microvascular dysfunction. During the ACh provocation test, we sampled blood simultaneously from the coronary sinus and aortic root to compare lactate concentrations. We quantified coronary blood flow volume using an intracoronary Doppler-tipped guidewire. We detected LGE in 34 patients (LGE-positive); 27 were LGE-negative. Coronary blood flow volume increased significantly after the ACh provocation test only in LGE-negative patients (before vs. after ACh, 47.5 ± 36.8 vs. 69.2 ± 48.0 ml/min, respectively; p = 0.004). The myocardial lactate extraction ratio (LER) significantly decreased after the ACh test in both groups (LGE-negative, p = 0.001; LGE-positive, p < 0.001), significantly more so in the LGE-positive group (p = 0.017). Multivariate logistic regression analysis showed that a post-ACh LER < 0 (indicating myocardial lactate production) was a significant predictor of LGE-positivity (odds ratio 4.54; 95 % confidence interval 1.38–14.93; p = 0.013). In the LGE-positive group, an LGE volume greater than the median significantly predicted a post-ACh LER of <0 (p = 0.042; odds ratio 6.02; 95 % confidence interval 1.07–33.86). ACh-provoked coronary vasomotor abnormality is closely correlated with myocardial fibrosis in patients with HF but without organic coronary stenosis. Coronary vasomotor abnormalities in fibrotic myocardium may worsen HF.

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Section: Discussionmentioning

confidence: 99%

Late gadolinium enhancement on cardiac magnetic resonance predicts coronary vasomotor abnormality and myocardial lactate production in patients with chronic heart failure

et al. 2016

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“…LGE was defined by a signal intensity of > 6 standard deviations above normal myocardium [26]. The LGE area was measured by manual planimetry using ImageJ software (National Institutes of Health, Bethesda, Maryland) in each short-axis image [27]. The area of the left ventricle was determined by manually tracing epicardial and endocardial borders in each short-axis image.…”

Section: Methodsmentioning

confidence: 99%

“…The area of the left ventricle was determined by manually tracing epicardial and endocardial borders in each short-axis image. The percentage area of LGE was then calculated by dividing the sum of the LGE areas by that of the total left ventricular area [27]. Data were presented both as percentage of the left ventricular area and as a binomial variable; positive/negative (Figures 1E and F).…”

Section: Methodsmentioning

confidence: 99%

High Sensitivity of Late Gadolinium Enhancement for Predicting Microscopic Myocardial Scarring in Biopsied Specimens in Hypertrophic Cardiomyopathy

et al. 2014

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BackgroundMyocardial scarring can be assessed by cardiac magnetic resonance imaging with late gadolinium enhancement and by endomyocardial biopsy. However, accuracy of late gadolinium enhancement for predicting microscopic myocardial scarring in biopsied specimens remains unknown in hypertrophic cardiomyopathy. We investigated whether late gadolinium enhancement in the whole heart reflects microscopic myocardial scarring in the small biopsied specimens in hypertrophic cardiomyopathy.Methods and ResultsTwenty-one consecutive patients with hypertrophic cardiomyopathy who were examined both by cardiac magnetic resonance imaging and by endomyocardial biopsy were retrospectively studied. The right interventricular septum was the target site for endomyocardial biopsy in all patients. Late gadolinium enhancement in the ventricular septum had an excellent sensitivity (100%) with a low specificity (40%) for predicting microscopic myocardial scarring in biopsied specimens. The sensitivity of late gadolinium enhancement in the whole heart remained 100% with a specificity of 27% for predicting microscopic myocardial scarring in biopsied specimens. Quantitative assessments of fibrosis revealed that the extent of late gadolinium enhancement in the whole heart was the only independent variable related to the microscopic collagen fraction in biopsied specimens (β = 0.59, 95% confident interval: 0.15 – 1.0, p = 0.012).ConclusionsAlthough there was a compromise in the specificity, the sensitivity of late gadolinium enhancement was excellent for prediction of microscopic myocardial scarring in hypertrophic cardiomyopathy. Moreover, the severity of late gadolinium enhancement was independently associated with the quantitative collagen fraction in biopsied specimens in hypertrophic cardiomyopathy. These findings indicate that late gadolinium enhancement can reflect both the presence and the extent of microscopic myocardial scarring in the small biopsied specimens in hypertrophic cardiomyopathy.

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“…Recently, we reported that the presence of LGE was significantly correlated with not only impaired LV relaxation, but also the downregulation of mitochondrial enzyme gene expression. 22 Mitochondrial dysfunction appears to be a common mechanism in the development of cardiac remodeling and failure. 23e25 Another explanation is that DCM patients with positive LGE appear to have an impaired response to therapeutic intervention.…”

Section: Lge-cmr As a Prognostic Toolmentioning

confidence: 99%

Prognostic Impact of Combined Late Gadolinium Enhancement on Cardiovascular Magnetic Resonance and Peak Oxygen Consumption in Ambulatory Patients With Nonischemic Dilated Cardiomyopathy

Yamada

Hirashiki

Okumura

et al. 2014

Journal of Cardiac Failure

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Relationship of Myocardial Fibrosis to Left Ventricular and Mitochondrial Function in Nonischemic Dilated Cardiomyopathy—A Comparison of Focal and Interstitial Fibrosis

Cited by 8 publications

References 40 publications

Late gadolinium enhancement on cardiac magnetic resonance predicts coronary vasomotor abnormality and myocardial lactate production in patients with chronic heart failure

Late gadolinium enhancement on cardiac magnetic resonance predicts coronary vasomotor abnormality and myocardial lactate production in patients with chronic heart failure

High Sensitivity of Late Gadolinium Enhancement for Predicting Microscopic Myocardial Scarring in Biopsied Specimens in Hypertrophic Cardiomyopathy

Prognostic Impact of Combined Late Gadolinium Enhancement on Cardiovascular Magnetic Resonance and Peak Oxygen Consumption in Ambulatory Patients With Nonischemic Dilated Cardiomyopathy

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