Association of Longitudinal Changes in Left Ventricular Structure and Function With Myocardial Fibrosis

Ambale-Venkatesh, Bharath; Volpe, Gustavo Jardim; Donekal, Sirisha; Mewton, Nathan; Liu, Chia-Ying; Shea, Steven; Liu, Kiang; Burke, Gregory L.; Wu, Colin O.; Bluemke, David A.; Lima, João A.C.

doi:10.1161/hypertensionaha.114.03697

Cited by 67 publications

(50 citation statements)

References 28 publications

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“…Although recent studies reported that lower postcontrast T1 times were associated with lower LV EDV and LV mass (22,23), we found that diffuse fibrosis was related to lower QRS amplitude independent of both LV EDV and mass. Therefore, the QRS amplitude can be even lower in the setting of increased diffuse fibrosis and decreased LV volume and mass according to myocyte loss.…”

Section: Cardiac Imaging: Electrocardiographic Impact Of Myocardial Dcontrasting

confidence: 94%

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Electrocardiographic Impact of Myocardial Diffuse Fibrosis and Scar: MESA (Multi-Ethnic Study of Atherosclerosis)

et al. 2017

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Purpose:To examine the associations of myocardial diffuse fibrosis and scar with surface electrocardiographic (ECG) parameters in individuals free of prior coronary heart disease in four different ethnicities. Materials and Methods:This prospective cross-sectional study was approved by the institutional review boards, and all participants gave informed consent. A total of 1669 participants in the Multi-Ethnic Study of Atherosclerosis, or MESA, who were free of prior myocardial infarction underwent both ECG and cardiac magnetic resonance imaging. In individuals without a late gadolinium enhancement-defined myocardial scar (n = 1131), T1 mapping was used to assess left ventricular (LV) interstitial diffuse fibrosis. The associations of LV diffuse fibrosis or myocardial scar with ECG parameters (QRS voltage, QRS duration, and corrected QT interval [QTc]) were evaluated by using multivariable regression analyses adjusted for demographic data, risk factors for scar, LV end-diastolic volume, and LV mass. Results:The mean age of the 1669 participants was 67.4 years 6 8.7 (standard deviation); 49.8% were women. Lower postcontrast T1 time at 12 minutes was significantly associated with lower QRS Sokolow-Lyon voltage (b = 15.1 µV/10 msec, P = .004), lower QRS Cornell voltage (b = 9.2 µV/10 msec, P = .031), and shorter QRS duration (b = 0.16 msec/10 msec, P = .049). Greater extracellular volume (ECV) fraction was also significantly associated with lower QRS Sokolow-Lyon voltage (b = 235.2 µV/1% ECV increase, P , .001) and Cornell voltage (b = 223.7 µV/1% ECV increase, P , .001), independent of LV structural indexes. In contrast, the presence of LV scar (n = 106) was associated with longer QTc (b = 4.3 msec, P = .031). Conclusion:In older adults without prior coronary heart disease, underlying greater LV diffuse fibrosis is associated with lower QRS voltage and shorter QRS duration at surface ECG, whereas clinically unrecognized myocardial scar is associated with a longer QT interval.q RSNA, 2016

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Section: Cardiac Imaging: Electrocardiographic Impact Of Myocardial Dcontrasting

confidence: 94%

“…The MESA cardiac MR imaging protocol and image analysis have been previously described in detail (22,23). Briefly, cardiac MR images were obtained by using 1.5-T imaging units (Avanto and …”

Section: Cardiac Mr Imagingmentioning

confidence: 99%

Electrocardiographic Impact of Myocardial Diffuse Fibrosis and Scar: MESA (Multi-Ethnic Study of Atherosclerosis)

et al. 2017

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“…Beyond sex differences in aortic material properties, there are also differences by sex with respect to myocardial fibrosis and ventricular remodeling in response to arterial loading conditions. In the Multi-Ethnic Study of Atherosclerosis, women had greater fibrosis than men and replacement myocardial fibrosis was related to LV concentric remodeling in women compared to LV dilation in men [41, 42]. Similarly, in senescent hearts, a steeper increase in LV mass was observed in women in contrast to men [43].…”

Section: Discussionmentioning

confidence: 99%

Association of Aortic Root Dilation from Early Adulthood to Middle Age with Cardiac Structure and Function: The CARDIA Study

Nwabuo

Moreira

Vasconcellos

et al. 2017

Journal of the American Society of Echocardiography

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BACKGROUND The human aorta dilates with advancing age. However, the association between progressive aortic dilation with aging and cardiac remodeling has not been established in studies of community-dwelling adults. We hypothesized that there would be a relationship between aortic size increase over the early adult lifespan with left ventricular (LV) structural remodeling and subclinical LV dysfunction in middle age, even in the absence of overt cardiovascular and valvular disease. METHODS Included were Coronary Artery Risk Development in Young Adults (CARDIA) study participants (n=2933) aged 23–35 years with available transthoracic echocardiography measurements during 20-years of follow-up. Multivariable linear regression models assessed sex-specific associations between 20-year change in aortic root diameter with LV structure and function. RESULTS Larger aortic root diameter at 20-year follow-up was associated with greater LV mass (2.77g/mm versus 2.18/mm, in men and women respectively, p<0.001). In longitudinal analyses, increase in aortic root diameter over 20-year follow up was associated with a greater 20-year increase in LV mass and LV Mass to LV end diastolic volume ratio in both sexes. In women but not in men, increased aortic root diameter over 20-years was associated with increased left atrial dimension, impaired E/E′ and impaired early diastolic longitudinal and circumferential strain rates assessed by speckle tracking echocardiography. CONCLUSIONS Progressive increase in aortic root diameter from early adulthood to middle age was associated with increased LV mass and LV concentric remodeling in both sexes and impaired diastolic function predominantly in women.

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“…In a subset of these participants, CMR was repeated approximately 10 years later (12). The CMR protocol and interpretation of LV parameters in MESA have been previously described and are included in the Online Appendix (13,14).…”

Section: Methodsmentioning

confidence: 99%

Histamine H 2 Receptor Antagonists, Left Ventricular Morphology, and Heart Failure Risk

Leary

Tedford

Bluemke

et al. 2016

Journal of the American College of Cardiology

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Background Myocardial H2 receptor activation may promote cardiac fibrosis and apoptosis in preclinical models and histamine H2 receptor antagonist (H2RA) use may improve symptoms in participants with heart failure (HF); however, relationships between H2RA use, incident HF, and longitudinal change in left ventricular (LV) morphology are not known. Objectives We sought to determine whether H2RA use is associated with incident HF and change in LV morphology over time. Methods This study included 6,378 men and women from MESA (Multi-Ethnic Study of Atherosclerosis), a multicenter prospective observational cohort of participants without cardiovascular disease at baseline. Cox proportional hazards were used to estimate the association between H2RA use and incident HF in adjusted models. In participants with cardiac magnetic resonance imaging (CMR), associations between H2RA use, baseline LV morphology (n = 4,691), and longitudinal change in the LV (n = 2,806) were estimated using linear regression. Results H2RAs were used by 313 participants but not by the other 6,065 individuals. During a median follow-up of 11.2 years, 236 participants developed HF. In adjusted models, baseline H2RA use relative to nonuse was associated with 62% lower risk for incident HF (p = 0.02). H2RA use was associated with preserved stroke volume, LV end-diastolic volume, and mass/volume ratio as measured by CMR over approximately 10 years (all p < 0.05). There were no associations between H2RA use and LV mass or ejection fraction. Conclusions H2RA use was associated with reduced risk for incident HF. Changes in left heart morphology over time suggest less age-related change in H2RA users. These associations suggest histamine signaling may be important in the pathogenesis of HF.

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Association of Longitudinal Changes in Left Ventricular Structure and Function With Myocardial Fibrosis

Cited by 67 publications

References 28 publications

Electrocardiographic Impact of Myocardial Diffuse Fibrosis and Scar: MESA (Multi-Ethnic Study of Atherosclerosis)

Electrocardiographic Impact of Myocardial Diffuse Fibrosis and Scar: MESA (Multi-Ethnic Study of Atherosclerosis)

Association of Aortic Root Dilation from Early Adulthood to Middle Age with Cardiac Structure and Function: The CARDIA Study

Histamine H 2 Receptor Antagonists, Left Ventricular Morphology, and Heart Failure Risk

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