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

Abstract

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.

Prevalence of Coronary Microvascular Disease and Coronary Vasospasm in Patients With Nonobstructive Coronary Artery Disease: Systematic Review and Meta‐Analysis

“…One hundred fifty‐five articles received a complete review, and 56 studies met inclusion criteria and were included in the meta‐analysis (Figure 2 ). 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , …”

Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery disease

“…On the other hand, ACh-provoked coronary vasomotor abnormality (e.g. epicardial coronary spasm or microvascular spasm) in our previous study was shown to be closely associated with myocardial fibrosis (expressed as late gadolinium enhancement in cardiac MRI) in patients with heart failure and without organic coronary artery stenosis [ 111 , 112 ]. Coronary vasomotor abnormalities such as coronary spasm or microvascular spasm could affect the development of nonobstructive CAD, and might also be associated with LV dysfunction and heart failure [ 4 , 19 , 54 , 113 – 117 ].…”

Correlation between microvascular dysfunction and B-type natriuretic peptide levels in non-ischemic heart failure patients with cardiac fibrosis

“…Recently we reported endothelium dependent microvascular dysfunction correlate with cardiac fibrosis in HF patients without coronary artery stenosis [16]. Therefore, we examined the relationship between CFR as a marker of endothelium independent microvascular function and cardiac fibrosis in this study.…”

“…Several studies have shown that the presence of late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) indicates myocardial fibrosis, predicting an increased risk of cardiovascular events and poor prognosis in patients with non-ischemic heart failure [14,15]. Recently, we reported that endothelial dependent microvascular dysfunction would worsen heart failure condition, especially with fibrotic myocardium [16].…”