Myocardial triglyceride content at 3 T cardiovascular magnetic resonance and left ventricular systolic function: a cross-sectional study in patients hospitalized with acute heart failure

Abstract

BackgroundIncreased myocardial triglyceride (TG) content has been recognized as a risk factor for cardiovascular disease. However, its relation with cardiac function in patients on recovery from acute heart failure (HF) remains unclear. In this cross-sectional study, we sought to investigate the association between myocardial TG content measured on magnetic resonance spectroscopy (1H-MRS) and left ventricular (LV) function assessed on cardiovascular magnetic resonance (CMR) in patients who were hospitalized with HF.MethodsA total of 50 patients who were discharged after hospitalization for acute HF and 21 age- and sex-matched controls were included in the study. Myocardial TG content and LV parameters (function and mass) were measured on a 3.0 T MR scanner. Fatty acid (FA) and unsaturated fatty acid (UFA) content was normalized against water (W) using the LC-Model algorithm. The patient population was dichotomized according to the left ventricular ejection fraction (LVEF, <50 % or ≥ 50 %).ResultsH-MRS data were available for 48 patients and 21 controls. Of the 48 patients, 25 had a LVEF <50 % (mean, 31.2 %), whereas the remaining 23 had a normal LVEF (mean, 60.2 %). Myocardial UFA/W ratio was found to differ significantly in patients with low LVEF, normal LVEF, and controls (0.79 % vs. 0.21 % vs. 0.14 %, respectively, p = 0.02). The myocardial UFA/TG ratio was associated with LV mass (r = 0.39, p < 0.001) and modestly related to LV end-diastolic volume (LVEDV; r = 0.24, p = 0.039). We also identified negative correlations of the myocardial FA/TG ratio with both LV mass (r = -0.39, p < 0.001) and LVEDV (r = -0.24, p = 0.039).ConclusionsAs compared with controls, patients who were discharged after hospitalization for acute HF had increased myocardial UFA content; furthermore, UFA was inversely related with LVEF, LV mass and, to a lesser extent, LVEDV. Our study may stimulate further research on the measure of myocardial UFA content by 1H-MRS for outcome prediction.Trial registrationClinicalTrial.gov: NCT02378402. Registered 27/02/2015 Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-016-0228-3) contains supplementary material, which is available to authorized users.

Left Ventricular Function and Myocardial Triglyceride Content on 3T Cardiac MR Predict Major Cardiovascular Adverse Events and Readmission in Patients Hospitalized with Acute Heart Failure

“…Our study explored the possibility of linking the dysregulation of myocardial TG with the future MACE, based on evidence showing the associations of myocardial TG and CV disease [6][7][8], plus the potential of quantitative readout of MRS in differentiating various lipid species in the myocardium [10]. Using this technique, we have previously shown that patients hospitalized for acute HF are characterized by increased myocardial UFA content [13]. The predictive value of myocardial TG contents-FA/UFA ratio and levels of lipid resonances δ 1.6 ppm, were further validated in the current case-control study.…”

“…Patients with a previous history of angina or myocardial infarction were defined as an ischemic group, while the others as non-ischemic group. Previously, 48 of the 133 patients have been reported in a cross-sectional interim report to study the association of LV function and myocardial TG on CMR [13]. In this study, we further evaluated their predictive value in a longitudinal observational study.…”

“…Clinical MRS was acquired before contrast administration using the same settings and anatomical localizations as previously reported [13]. In brief, respiratory-triggered cardiac-gated point-resolved spectroscopy (PRESS) [17] was implemented to acquire localized 1 H MRS voxels to a 2 × 2 × 1 cm 3 spectroscopic volume within the interventricular septum during the end-systolic phase.…”

“…Proton magnetic resonance spectroscopy ( 1 H-MRS) has been used to obtain in vivo quantitative measures of myocardial TG content in patients with CV disorders [10][11][12]. We have previously used 3.0 T CMR to analyze the association between myocardial unsaturated fatty acids (UFA) content and left ventricular (LV) function in patients who had been hospitalized for acute HF [13]. Furthermore, cardiac magnetic resonance imaging (CMR) is well established as the gold standard in the assessment of cardiac structure and function, with incremental diagnostic and prognostic information in HF [14][15][16].…”

Review of Journal of Cardiovascular Magnetic Resonance (JCMR) 2015-2016 and transition of the JCMR office to Boston

“…Increased myocardial triglyceride (TG) content has been recognized as a risk factor for cardiovascular disease. Liao et al [ 204 ] performed 3 T CMR 1H spectroscopy in 50 patients (including 25 with left ventricular ejection fraction <50%) discharged after hospitalization for acute heart failure and 21 age and sex matched controls. Myocardial unsaturated fatty acid/water ratio was found to be differ (0.79% vs. 0.21% vs. 0.14%) between the low ejection fraction heart failure, normal ejection fraction heart failure and healthy controls, respectively.…”