Cardiac extracellular matrix is associated with adverse outcome in patients with chronic heart failure

Duca, Franz; Zotter-Tufaro, Caroline; Kammerlander, Andreas A.; Panzenböck, Adelheid; Aschauer, Stefan; Dalos, Daniel; Köll, Benedikt; Börries, Benedikt; Agis, Hermine; Kain, Renate; Aumayr, Klaus; Klinglmüller, Florian; Mascherbauer, Julia; Bonderman, Diana

doi:10.1002/ejhf.680

Cited by 19 publications

(11 citation statements)

References 47 publications

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“…So far, several studies have compared results of T1-mapping with histological findings of left ventricular biopsies and found that ECV reflects the amount of diffuse myocardial fibrosis in patients with aortic stenosis [ 4 , 7 , 8 , 13 ], hypertrophic cardiomyopathy [ 4 , 10 ], heart failure [ 9 , 11 , 30 ], dilated cardiomyopathy [ 6 , 12 ] and mixed patient populations [ 14 ]. Furthermore, a small number of studies investigated the impact of T1-mapping on survival and found that higher amounts of diffuse fibrosis are associated with an increased event rate [ 11 , 14 , 23 , 30 – 32 ]. Particularly in infiltrative diseases, T1-mapping has evolved as an important diagnostic tool.…”

Section: Discussionmentioning

confidence: 99%

Extracellular volume quantification by cardiac magnetic resonance imaging without hematocrit sampling

Kammerlander

Duca

Binder

et al. 2017

Wien Klin Wochenschr

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SummaryBackgroundMyocardial tissue characterization by cardiovascular magnetic resonance (CMR) T1 mapping currently receives increasing interest as a diagnostic tool in various disease settings. The T1-mapping technique allows non-invasive estimation of myocardial extracellular volume (ECV) using T1-times before and after gadolinium administration; however, for calculation of the myocardial ECV the hematocrit is needed, which limits its utility in routine application. Recently, the alternative use of the blood pool T1-time instead of the hematocrit has been described.MethodsThe results of CMR T1 mapping data of 513 consecutive patients were analyzed for this study. Blood for hematocrit measurement was drawn when placing the i. v. line for contrast agent administration. Data from the first 200 consecutive patients (derivation cohort) were used to establish a regression formula allowing synthetic hematocrit calculation, which was then validated in the following 313 patients (validation cohort). Synthetic ECV was calculated using synthetic hematocrit, and was compared with conventionally derived ECV.ResultsAmong the entire cohort of 513 patients (mean age 57.4 ± 17.5 years old, 49.1% female) conventionally measured hematocrit was 39.9 ± 4.7% and native blood pool T1-time was 1570.6 ± 117.8 ms. Hematocrit and relaxivity of blood (R1 = 1/blood pool T1 time) were significantly correlated (r = 0.533, r2 = 0.284, p < 0.001). By linear regression analysis, the following formula was developed from the derivation cohort: synthetic hematocrit = 628.5 × R1 − 0.002. Synthetic and conventional hematocrit as well as ECV showed significant correlation in the validation (r = 0.533, r2 = 0.284, p < 0.001 and r = 0.943, r2 = 0.889, p < 0.001, respectively) as well as the overall cohort (r = 0.552, r2 = 0.305, p < 0.001 and r = 0.957, r2 = 0,916, p < 0.001). By Bland Altman analysis, good agreement between conventional and synthetic ECV was found in the validation cohort (mean difference: 0.007%, limits of agreement: −4.32 and 4.33%, respectively).ConclusionSynthetic ECV using native blood pool T1-times to calculate the hematocrit, is feasible and leads to almost identical results in comparison with the conventional method. It may allow fully automatic ECV-mapping and thus enable broader use of ECV by CMR T1 mapping in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Extracellular volume quantification by cardiac magnetic resonance imaging without hematocrit sampling

Kammerlander

Duca

Binder

et al. 2017

Wien Klin Wochenschr

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“…This finding suggests that the size of the ROI has less of an effect on the ECV measurement based on the ROI-based method. CMR-derived ECV is a useful biomarker to quantify diffuse interstitial matrix 2,5,8,12 and predict adverse cardiovascular outcomes [13][14][15] . ECV is most often measured using an ROI-based method, which assumes that the myocardial abnormality is homogeneously distributed (uniform ECV) within the noninfarcted myocardial regions.…”

Section: Discussionmentioning

confidence: 99%

CMR-derived ECVs vary with myocardial region and associate with the regional wall thickness

Hou

Liu

et al. 2020

Sci Rep

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This study was designed to identify whether the position and size of the region of interest (ROI) influence extracellular volume fraction (ECV) measurements. Patients with localized (n = 203) or infiltrative (n = 215) cardiomyopathies and 36 normal controls were enrolled in this study. ECV measurements at 4 different regions, including the anterior, septal, posterior and lateral wall regions, were measured, and all groups were compared. Regional ECV was correlated with the corresponding regional wall thickness. The diagnostic power to differentiate the myocardial abnormalities was evaluated for each myocardial region. ECVs measured using five different ROI sizes within each myocardial region were compared. Our results showed that ECVs varied among the myocardial regions, and this variation was significantly associated with regional wall thicknesses. For the detection of myocardial abnormalities, regional ECV revealed similar results as ECV derived from the whole region except for the anterior region. No significant difference was found in the ECVs measured using the five different ROI sizes. In conclusion, CMR-derived ECVs vary with myocardial region, and this variation is significantly associated with the regional wall thickness. In contrast, the measured size of the ROI has less of an effect on the ECV.

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“…Extracellular matrix area was measured by endomyocardial biopsy in 73 patients with HF. A larger area was associated with a greater impairment of exercise haemodynamics and with poorer prognosis, confirming the potential role of fibrosis as a treatment target …”

Section: Cardiomyopathiesmentioning

confidence: 85%

April 2017 at a glance: cardiomyopathies and clinical trials

Metra

2017

European J of Heart Fail

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Cardiac extracellular matrix is associated with adverse outcome in patients with chronic heart failure

Abstract: ECM area within the LV myocardium correlates with left and right heart haemodynamics and is associated with clinical course in various non-ischaemic HF types.

Cited by 19 publications

References 47 publications

Extracellular volume quantification by cardiac magnetic resonance imaging without hematocrit sampling

Extracellular volume quantification by cardiac magnetic resonance imaging without hematocrit sampling

CMR-derived ECVs vary with myocardial region and associate with the regional wall thickness

April 2017 at a glance: cardiomyopathies and clinical trials

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