Left Ventricular Myocardial Fibrosis, Atrophy, and Impaired Contractility in Patients With Pulmonary Arterial Hypertension and a Preserved Left Ventricular Function

Homsi, Rami; Luetkens, Julian A.; Skowasch, Dirk; Pizarro, Carmen; Sprinkart, Alois M.; Gieseke, J; Meyer-Arend, Julia Meyer zur Heide gen.; Schild, Hans H.; Naehle, Claas P.

doi:10.1097/rti.0000000000000248

Cited by 43 publications

(35 citation statements)

References 38 publications

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“…17,18 Fat-water separation sequences such as Dixon provide volumetric quantification of fat. [19][20][21][22][23] Tereshchenko et al demonstrated that interatrial septum fat, measured in the interatrial septum using a fat-water separated sequence, was associated with AF risk. 24 LA-epicardial fat shows a quite nonuniform spatial distribution.…”

mentioning

confidence: 99%

Left Atrial Epicardial Fat Volume Is Associated With Atrial Fibrillation: A Prospective Cardiovascular Magnetic Resonance 3D Dixon Study

Nakamori

Nezafat

Ngo

et al. 2018

JAHA

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BackgroundRecent studies demonstrated a strong association between atrial fibrillation (AF) and epicardial fat around the left atrium (LA). We sought to assess whether epicardial fat volume around the LA is associated with AF, and to determine the additive value of LA‐epicardial fat measurements to LA structural remodeling for identifying patients with AF using 3‐dimensional multi‐echo Dixon fat–water separated cardiovascular magnetic resonance.Methods and ResultsA total of 105 subjects were studied: 53 patients with a history of AF and 52 age‐matched patients with other cardiovascular diseases but no history of AF. The 3‐dimensional multi‐echo Dixon fat‐water separated sequence was performed for LA‐epicardial fat measurements. AF patients had significantly greater LA‐epicardial fat (28.9±12.3 and 14.2±7.3 mL for AF and non‐AF, respectively; P<0.001) and LA volume (110.8±38.2 and 89.7±30.3 mL for AF and non‐AF, respectively; P=0.002). LA‐epicardial fat adjusted for LA volume was still higher in patients with AF compared with those without AF (P<0.001). LA‐epicardial fat and hypertension were independently associated with the risk of AF (odds ratio, 1.17; 95% confidence interval, 1.10%–1.25%, P<0.001, and odds ratio, 3.29; 95% confidence interval, 1.17%–9.27%, P=0.03, respectively). In multivariable logistic regression analysis adjusted for body surface area, LA‐epicardial fat remained significant and an increase per mL was associated with a 42% increase in the odds of AF presence (odds ratio, 1.42; 95% confidence interval, 1.23%–1.62%, P<0.001). Combined assessment of LA‐epicardial fat and LA volume provided greater discriminatory performance for detecting AF than LA volume alone (c‐statistic=0.88 and 0.74, respectively, DeLong test; P<0.001).ConclusionsCardiovascular magnetic resonance 3‐dimensional Dixon‐based LA‐epicardial fat volume is significantly increased in AF patients. LA‐epicardial fat measured by 3‐dimensional Dixon provides greater performance for detecting AF beyond LA structural remodeling.

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confidence: 99%

Left Atrial Epicardial Fat Volume Is Associated With Atrial Fibrillation: A Prospective Cardiovascular Magnetic Resonance 3D Dixon Study

Nakamori

Nezafat

Ngo

et al. 2018

JAHA

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“…investigated LV myocardial changes associated with PAH by strain analysis and mapping techniques. 107 Both native T1 and ECV were higher in patients with PAH and LV longitudinal strain was impaired (–18 vs. –23, P < 0.01). However, there was no change in LVEF.…”

Section: Myocardial Tissue Characterization and Myocardial Perfusion mentioning

confidence: 89%

Non‐invasive imaging of global and regional cardiac function in pulmonary hypertension

2017

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Pulmonary hypertension (PH) is a progressive illness characterized by elevated pulmonary artery pressure; however, the main cause of mortality in PH patients is right ventricular (RV) failure. Historically, improving the hemodynamics of pulmonary circulation was the focus of treatment; however, it is now evident that cardiac response to a given level of pulmonary hemodynamic overload is variable but plays an important role in the subsequent prognosis. Non-invasive tests of RV function to determine prognosis and response to treatment in patients with PH is essential. Although the right ventricle is the focus of attention, it is clear that cardiac interaction can cause left ventricular dysfunction, thus biventricular assessment is paramount. There is also focus on the atrial chambers in their contribution to cardiac function in PH. Furthermore, there is evidence of regional dysfunction of the two ventricles in PH, so it would be useful to understand both global and regional components of dysfunction. In order to understand global and regional cardiac function in PH, the most obvious non-invasive imaging techniques are echocardiography and cardiac magnetic resonance imaging (CMRI). Both techniques have their advantages and disadvantages. Echocardiography is widely available, relatively inexpensive, provides information regarding RV function, and can be used to estimate RV pressures. CMRI, although expensive and less accessible, is the gold standard of biventricular functional measurements. The advent of 3D echocardiography and techniques including strain analysis and stress echocardiography have improved the usefulness of echocardiography while new CMRI technology allows the measurement of strain and measuring cardiac function during stress including exercise. In this review, we have analyzed the advantages and disadvantages of the two techniques and discuss pre-existing and novel forms of analysis where echocardiography and CMRI can be used to examine atrial, ventricular, and interventricular function in patients with PH at rest and under stress.

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“…In contrast to systemic hypertension without LV hypertrophy, pulmonary hypertension was found to be associated with increased native LV and RV myocardial T1 and ECV regardless of the underlying disease etiology [88][89][90][91][92]. Increased native T1 values at the ventricular insertion points (Fig.…”

Section: Eccentric Left Ventricular Hypertrophymentioning

confidence: 99%

“…In a recent study, Caspar et al [99] reported various etiologies of intracardiac masses including myxoma, recent and old thrombi, hemangioma, lymphoma, lipoma, fibroelastoma, rhabdomyoma, caseous calcification, and metastasis. Besides it's supportive nature to standard CMR characterization [90], it remains to date unclear if and to what extend myocardial T1 mapping will contribute to the differentiation of cardiac masses. Taking into account the heterogeneous nature of cardiac masses (Fig.…”

Section: Cardiac Tumors and Massesmentioning

confidence: 99%

“…As shown in Fig. 14 the decrease of post-contrast T1 values in a pericardial cyst is not related to contrast agent uptake but rather larger underestimation/more incomplete relaxation of the longitudinal magnetization of high T1 values by post-contrast MOLLI 4(1)3(1)2 compared to the pre-contrast MOLLI 5(3)3 protocol (see part 1 of this review (doi: 10.1016/j.ejrad.2018.10.011)). Moreover, it is to be expected that evaluation algorithms beyond simple average T1 or ECV values will be needed for advanced, quantitative characterization of cardiac masses (e.g., ranges within the entire mass or T1/T2 profiles [90]). Fig.…”

Section: Cardiac Tumors and Massesmentioning

confidence: 99%

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Cardiac magnetic resonance T1 mapping. Part 2: Diagnostic potential and applications

Reiter

Kräuter

et al. 2018

European Journal of Radiology

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Non-invasive identification and differentiation of myocardial diseases represents the primary objectives of cardiac magnetic resonance (CMR) longitudinal relaxation time (T1) and extracellular volume (ECV) mapping. Given the fact that myocardial T1 and ECV values overlap throughout and within left ventricular phenotypes, a central issue to be addressed is whether and to what extent myocardial T1 and ECV mapping provides additional or superior diagnostic information to standard CMR imaging, and whether native T1 mapping could be employed as a non-contrast alternative to late gadolinium enhancement (LE) imaging. The present review aims to summarize physiological and pathophysiological alterations in native T1 and ECV values and summarized myocardial T1 and ECV alterations associated with cardiac diseases to support the translation of research findings into routine CMR imaging.

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Left Ventricular Myocardial Fibrosis, Atrophy, and Impaired Contractility in Patients With Pulmonary Arterial Hypertension and a Preserved Left Ventricular Function

Abstract: In patients with PAH, changes in T1 and ECV support the hypothesis of LV myocardial fibrosis and atrophy with a consecutively impaired contractility despite a preserved LV function, possibly due to longstanding PAH-associated LV underfilling.

Cited by 43 publications

References 38 publications

Left Atrial Epicardial Fat Volume Is Associated With Atrial Fibrillation: A Prospective Cardiovascular Magnetic Resonance 3D Dixon Study

Left Atrial Epicardial Fat Volume Is Associated With Atrial Fibrillation: A Prospective Cardiovascular Magnetic Resonance 3D Dixon Study

Non‐invasive imaging of global and regional cardiac function in pulmonary hypertension

Cardiac magnetic resonance T1 mapping. Part 2: Diagnostic potential and applications

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