The Association between Left Ventricular Diastolic Dysfunction and Myocardial Scar and Their Collective Impact on All-Cause Mortality

Wang, Lin; Singh, Harsimar; Mulyala, Rajasekhar; Weber, Jonathan; Barasch, Eddy; Cao, Jie J

doi:10.1016/j.echo.2019.09.022

Cited by 11 publications

(9 citation statements)

References 39 publications

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“…After qualitative analysis of the presence or absence of LGE, we also applied a semiquantitative evaluation to calculate segmental LGE score (sLGEs) based on the extent of LGE: no LGE involvement of the segment = 0, 1 to 50% LGE involvement of the segment = 1, and 51 to 100% LGE involvement of the segment = 2. Therefore, the total LGE score (tLGEs) of 17 segments ranged from 0 to 34 ( 24 ). Native T1 and ECV were analyzed semiautomatically via cvi42 software (version 5.3, Circle Cardiovascular Imaging, Calgary, Canada).…”

Section: Methodsmentioning

confidence: 99%

Predictive Value of Echocardiographic Strain for Myocardial Fibrosis and Adverse Outcomes in Autoimmune Diseases

Jia

Xiao

Zhang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundMyocardial fibrosis is an important pathophysiologic mechanism of cardiac involvement that leads to increased mortality in patients with autoimmune diseases (AIDs). The aim of this study was to evaluate the association between myocardial strain from speckle-tracking echocardiography (STE) and fibrosis on cardiovascular magnetic resonance (CMR) and to further explore their prognostic implications in patients with AIDs.MethodsWe prospectively included 102 AIDs patients with clinically suspected cardiac involvement and 102 age- and sex-matched healthy individuals. Patients underwent CMR for evaluation of myocardial fibrosis by late gadolinium enhancement (LGE) and T1 mapping. A semiquantitative evaluation based on the extent of LGE was used to calculate the total (tLGEs) and segmental (sLGEs) LGE score. Global longitudinal strain (GLS) was evaluated by STE in all subjects. All patients were regularly followed up every 6 months. The primary endpoint was the composite incidence of all-cause death and cardiovascular hospitalization.ResultsCompared to healthy controls, AIDs patients had impaired GLS (−17.9 ± 5.1% vs. −21.2 ± 2.5%, p < 0.001). LGE was detected in 70% of patients. Patients with LGE presented worse GLS (−17.1 ± 5.3% vs. −19.6 ± 4.1%, p = 0.018) than those without LGE. On multivariate logistic analysis, GLS ≥ −15% was an independent predictor of LGE presence (OR = 4.98, 95%CI 1.35–18.33, p = 0.016). Moreover, a marked and stepwise impairment of segmental longitudinal strain (−19.3 ± 6.6 vs. −14.9 ± 6.5 vs. −8.9 ± 6.3, p < 0.001) was observed as sLGEs increased. During a median follow-up time of 25 months, 6 patients died, and 14 patients were hospitalized for cardiovascular reasons. Both GLS ≥ −15% (HR 3.56, 95%CI 1.28–9.86, p = 0.015) and tLGEs ≥ 6 (HR 4.13, 95%CI 1.43–11.92, p = 0.009) were independently associated with the primary endpoint.ConclusionsIn AIDs patients, impaired myocardial strain on STE could reflect the presence and extent of myocardial fibrosis and provide incremental prognostic value in addition to LGE in the prediction of adverse outcomes.

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Section: Methodsmentioning

confidence: 99%

Predictive Value of Echocardiographic Strain for Myocardial Fibrosis and Adverse Outcomes in Autoimmune Diseases

Jia

Xiao

Zhang

et al. 2022

Front. Cardiovasc. Med.

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“…By comparison, a recent larger study (n=607) found an association between a semiquantitative assessment of LGE extent and diastolic dysfunction grade 26 . The patient group was heterogeneous, with both ischemic and non-ischemic reasons for exhibiting LGE, and the time elapsed between the disease causing LGE and the time of examination was not taken into consideration, to the extent that it even was known.…”

Section: Discussionmentioning

confidence: 83%

The size of myocardial infarction and peri-infarction edema are not major determinants of diastolic impairment after acute myocardial infarction

Sundqvist

Verouhis

Sörensson

et al. 2022

Preprint

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AimsDiastolic dysfunction after myocardial infarction (MI) is a marker of poor prognosis. The relationship between myocardial infarction size (IS), myocardial edema, and diastolic dysfunction is poorly understood, both in the acute phase, and in the development of diastolic dysfunction in the follow-up setting. Using a mechanistic approach could potentially add insights.Methods and resultsPatients underwent cardiovascular magnetic resonance (CMR) imaging and echocardiography including mechanistic analysis using the parameterized diastolic filling method within 4-7 days (acute) and 6 months after a first acute anterior MI (n=74). Linear regression modeling of echocardiographic diastolic parameters using CMR IS with and without inclusion of the myocardium at risk (MAR) and model comparisons with likelihood ratio tests were performed. Diastolic parameters at 6 months follow-up were modelled using final IS. For most parameters there was no association with acute IS, except for deceleration time (R2=0.24, p<0.001), left atrial volume index (R2=0.13, p=0.01) and the mechanistic stiffness parameter (R2=0.21, p<0.001). Adding MAR improved only the e′ model (adjusted R2 increase: 0.08, p=0.02). At 6 months follow-up, final IS was only associated with viscoelastic energy loss (R2=0.22, p=0.001).ConclusionIn acute MI, both IS and MAR are related to diastolic function but only to a limited extent. At 6 months after infarction, increasing IS is related to less viscoelastic energy loss, albeit also to a limited extent. The relationship between IS and diastolic dysfunction seems to be mediated by mechanisms beyond simply the spatial extent of ischemia or infarction.

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“…A balance should ideally exist between synthesis and degradation of extracellular matrix components, and inadequate deposition of scar components and impaired collagen assembly can lead to wall thinning, aneurysm formation, and eventually cardiac rupture or heart failure (Ma et al 2014 ). Conversely, excessive collagen accumulation and extensive scarring correlates with increased wall stiffness and development of diastolic dysfunction (Moreo et al 2009 ; Wang et al 2020 ). However, controlled collagen cleavage is required for efficient scar formation (Nong et al 2011 ).…”

Section: Discussionmentioning

confidence: 99%

Fourier analysis of collagen bundle orientation in myocardial infarction scars

Marcos‐Garcés

Ríos‐Navarro

Gómez-Torres

et al. 2022

Histochem Cell Biol

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Collagen bundle orientation (CBO) in myocardial infarct scars plays a major role in scar mechanics and complications after infarction. We aim to compare four histopathological methods for CBO measurement in myocardial scarring. Myocardial infarction was induced in 21 pigs by balloon coronary occlusion. Scar samples were obtained at 4 weeks, stained with Masson’s trichrome, Picrosirius red, and Hematoxylin–Eosin (H&E), and photographed using light, polarized light microscopy, and confocal microscopy, respectively. Masson’s trichrome images were also optimized to remove non-collagenous structures. Two observers measured CBO by means of a semi-automated, Fourier analysis protocol. Interrater reliability and comparability between techniques were studied by the intraclass correlation coefficient (ICC) and Bland–Altman (B&A) plots and limits of agreement. Fourier analysis showed an almost perfect interrater reliability for each technique (ICC ≥ 0.95, p < 0.001 in all cases). CBO showed more randomly oriented values in Masson’s trichrome and worse comparability with other techniques (ICC vs. Picrosirius red: 0.79 [0.47–0.91], p = 0.001; vs. H&E-confocal: 0.70 [0.26–0.88], p = 0.005). However, optimized Masson’s trichrome showed almost perfect agreement with Picrosirius red (ICC 0.84 [0.6–0.94], p < 0.001) and H&E-confocal (ICC 0.81 [0.54–0.92], p < 0.001), as well as these latter techniques between each other (ICC 0.84 [0.60–0.93], p < 0.001). In summary, a semi-automated, Fourier-based method can provide highly reproducible CBO measurements in four different histopathological techniques. Masson’s trichrome tends to provide more randomly oriented CBO index values, probably due to non-specific visualization of non-collagenous structures. However, optimization of Masson’s trichrome microphotographs to remove non-collagenous components provides an almost perfect comparability between this technique, Picrosirius red and H&E-confocal.

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The Association between Left Ventricular Diastolic Dysfunction and Myocardial Scar and Their Collective Impact on All-Cause Mortality

Cited by 11 publications

References 39 publications

Predictive Value of Echocardiographic Strain for Myocardial Fibrosis and Adverse Outcomes in Autoimmune Diseases

Predictive Value of Echocardiographic Strain for Myocardial Fibrosis and Adverse Outcomes in Autoimmune Diseases

The size of myocardial infarction and peri-infarction edema are not major determinants of diastolic impairment after acute myocardial infarction

Fourier analysis of collagen bundle orientation in myocardial infarction scars

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