Utility of galectin-3 in predicting post-infarct remodeling after acute myocardial infarction based on extracellular volume fraction mapping

Abstract Aims: To investigate the differential contribution of the left atrial (LA) function and left ventricular (LV) fibrosis to pulmonary arterial systolic pressure (PASP) in reperfused acute myocardial infarction (AMI), hypertrophic cardiomyopathy (HCM), and dilated cardiomyopathy (DCM). Methods and Results: Data of 370 patients with HCM (n=133), reperfused AMI (n=123), and DCM (n=114) who underwent both echocardiography and cardiovascular magnetic resonance (CMR) were comprehensively reviewed. Phasic LA volumes, LA-global longitudinal strain (GLS), and extracellular volume fraction (ECV) of LV were measured using CMR. E/e’ was correlated with PASP in all groups; however, the predicted value was significantly attenuated after adjusting for LA volume and LA strain in HCM and DCM, but remained significant in AMI. The E/e’/LA-GLS was related to PASP in HCM (p=0.01) and DCM (p=0.03) independent of LA volume index and E/e', but not in AMI. In DCM, ECV was significantly related to PASP (p<0.001) independent of LA volume index and E/e’. When subdivided according to the linear regression between PASP and E/e’, patients in the discrepantly high PASP group had lower total emptying fraction and reservoir fraction of left atrium in HCM and DCM but not in AMI compared to the good correlation group. Conclusions: The LA function in HCM and DCM and LV fibrosis in DCM correlated with PASP independent of E/e’ and LA size, contrary to that in AMI. These results suggest the presence of atrial myopathy in non-ischemic cardiomyopathies and usefulness of ECV measurement in DCM for the comprehensive evaluation of LV diastolic function.

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Myocardial extracellular volume quantification by computed tomography predicts outcomes in patients with severe aortic stenosis

PLoS ONE ◽

10.1371/journal.pone.0248306 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248306

Author(s):

Yoav Hammer ◽

Yeela Talmor-Barkan ◽

Aryeh Abelow ◽

Katia Orvin ◽

Yaron Aviv ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Valve ◽

Aortic Stenosis ◽

Volume Fraction ◽

Severe Aortic Stenosis ◽

Extracellular Volume ◽

Normal Subjects ◽

Extracellular Volume Fraction ◽

Left Ventricular ◽

Galectin 3

Background The extent of myocardial fibrosis in patients with severe aortic stenosis might have an important prognostic value. Non-invasive imaging to quantify myocardial fibrosis by measuring extracellular volume fraction might have an important clinical utility prior to aortic valve intervention. Methods Seventy-five consecutive patients with severe aortic stenosis, and 19 normal subjects were prospectively recruited and underwent pre- and post-contrast computed tomography for estimating myocardial extracellular volume fraction. Serum level of galectin-3 was measured and 2-dimensional echocardiography was performed to characterize the extent of cardiac damage using a recently published aortic stenosis staging classification. Results Extracellular volume fraction was higher in patients with aortic stenosis compared to normal subjects (40.0±11% vs. 21.6±5.6%; respectively, p<0.001). In patients with aortic stenosis, extracellular volume fraction correlated with markers of left ventricular decompensation including New York Heart Association functional class, left atrial volume, staging classification of aortic stenosis and lower left ventricular ejection fraction. Out of 75 patients in the AS group, 49 underwent TAVI, 6 surgical AVR, 2 balloon valvuloplasty, and 18 did not undergo any type of intervention. At 12-months after aortic valve intervention, extracellular volume fraction predicted the combined outcomes of stroke and hospitalization for heart failure with an area under the curve of 0.77 (95% confidence interval: 0.65–0.88). A trend for correlation between serum galectin-3 and extracellular volume was noted. Conclusion In patients with severe aortic stenosis undergoing computed tomography before aortic valve intervention, quantification of extracellular volume fraction correlated with functional status and markers of left ventricular decompensation, and predicted the 12-months composite adverse clinical outcomes. Implementation of this novel technique might aid in the risk stratification process before aortic valve interventions.

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