scholarly journals Diffuse myocardial fibrosis precedes impairment of myocardial strain in patients with systemic sclerosis

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
A Gotschy ◽  
S Jordan ◽  
CT Stoeck ◽  
C Von Deuster ◽  
M Gastl ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Myocardial Fibrosis ◽  
Functional Impairment ◽  
Myocardial Strain ◽  
Extracellular Volume ◽  
Diffuse Myocardial Fibrosis ◽  
Healthy Controls ◽  
Post Contrast ◽  
Native T1 ◽  
Myocardial Involvement

Abstract Funding Acknowledgements Type of funding sources: None. Background - Myocardial involvement is common in patients with systemic sclerosis (SSc) and causes myocardial fibrosis and subtle ventricular dysfunction. However, the temporal onset of myocardial involvement during the progression of the disease is yet unknown. Purpose - To investigated the presence of subclinical functional impairment and diffuse myocardial fibrosis in patients with very early diagnosis of SSc (VEDOSS) and to compared the findings to patients with established SSc and healthy controls. Methods - 110 SSc patients (86 with established SSc and 24 with VEDOSS) and 15 healthy controls were prospectively recruited. The study subjects underwent cardiovascular magnetic resonance on a clinical 1.5T system. Pre- and post-contrast T1 mapping was performed using a MOLLI (Modified Look-Locker Inversion Recovery) sequence. For extracellular volume (ECV) measurements, a single bolus protocol with image acquisition 15-20 min. post-contrast injection was used. For the assessment of subtle functional impairment, global longitudinal (GLS) and circumferential (GCS) myocardial strain were evaluated. Results - Native T1 values and ECV were elevated in VEDOSS and in patients with established SSc compared to controls (p < 0.001; Figure 1 A & B). GLS was similar in VEDOSS and controls but significantly reduced in patients with established SSc (p < 0.001; Figure 1 C). GCS was similar over all groups (p = 0.88). Patients with clinical evidence of pulmonary or gastrointestinal involvement had higher ECV or T1 values, respectively. Patients with clinical signs of cardiac involvement had lower absolute GLS. SSc subtype, classification or disease duration were not associated with the extent of myocardial fibrosis or impaired strain. Conclusion - Subclinical myocardial involvement first manifests as diffuse myocardial fibrosis identified by expansion of ECV and increased native T1 in VEDOSS patients while subtle functional impairment as measured by GLS only occurs in established SSc. No single clinical feature of SSc shows a strong association with subtle myocardial involvement.

Decreased Native T1 Values and Impaired Myocardial Contractility in Anabolic Steroid Users

2021 ◽  
Author(s):  
Francis Ribeiro de Souza ◽  
Marcelo Rodrigues dos Santos ◽  
Carlos Eduardo Rochitte ◽  
Rafael Parenquine dos Santos ◽  
Camila Paixão Jordão ◽  
...  
Keyword(s):  
Myocardial Fibrosis ◽  
Myocardial Contractility ◽  
Longitudinal Strain ◽  
Tissue Characterization ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Extracellular Volume ◽  
Radial Strain ◽  
Lv Function ◽  
Native T1

AbstractAnabolic androgenic steroid (AAS) abuse leads to myocardial toxicity. Human studies are conflicting about the myocardial fibrosis in AAS users. We evaluated cardiac tissue characterization, left ventricle (LV) function, and cardiac structure by cardiovascular magnetic resonance (CMR). Twenty strength-trained AAS users (AASU) aged 29±5 yr, 20 strength-trained AAS nonusers (AASNU), and 7 sedentary controls (SC) were enrolled. Native T1 mapping, late-gadolinium enhancement (LGE), extracellular volume (ECV), and myocardial strain were evaluated. AASU showed lower Native T1 values than AASNU (888±162 vs. 1020±179 ms p=0.047). Focal myocardial fibrosis was found in 2 AASU. AASU showed lower LV radial strain (30±8 vs. 38±6%, p<0.01), LV circumferential strain (–17±3 vs. −20±2%, p<0.01), and LV global longitudinal strain (–17±3 vs. –20±3%, p<0.01) than AASNU by CMR. By echocardiography, AASU demonstrated lower 4-chamber longitudinal strain than AASNU (–15±g3 vs. –18±2%, p=0.03). ECV was similar among AASU, AASNU, and SC (28±10 vs. 28±7 vs. 30±7%, p=0.93). AASU had higher LV mass index than AASNU and SC (85±14 vs. 64±8 vs. 58±5 g/m2, respectively, p<0.01). AAS abuse may be linked to decreased myocardial native T1 values, impaired myocardial contractility, and focal fibrosis. These alterations may be associated with maladaptive cardiac hypertrophy in young AAS users.

P1023Upstream therapy with spironolactone in patients with atrial fibrillation may reduce the burden of diffuse myocardial fibrosis and arrhythmia

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Rujic ◽  
P L Madsen ◽  
M Pareek ◽  
T Juhl Hansen ◽  
K Egstrup
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Myocardial Fibrosis ◽  
Longitudinal Strain ◽  
Low Dose ◽  
Myocardial Strain ◽  
Diffuse Myocardial Fibrosis ◽  
Diffuse Fibrosis ◽  
Double Blind Study ◽  
Post Contrast

Abstract Background The pathophysiology of atrial fibrillation (AF) involves a continuum of structural, hemodynamic, and electrophysical remodeling that coexist in a complex interplay, often involving increased diffuse myocardial fibrosis. Purpose To examine whether low dose spironolactone can reduce the extent of diffuse fibrosis in the left atrium (LA) and left ventricle (LV), evaluated using post-contrast T1 myocardial relaxation time (T1 time) and myocardial strain derived from cardiac magnetic resonance imaging (CMR), in patients with paroxysmal and persistent AF. Methods CMR sub-study population of 100 individuals from INSPIRE-AF, an investigator-initiated, randomized, controlled, double-blind study (NCT02764619). Study participants with paroxysmal (n=49) and persistent (n=51) non-valvular AF and LV ejection fraction ≥45% were randomized to spironolactone 25 mg once daily (SPL-group, n=49) or placebo (PL-group, n=51) in addition to standard treatment. CMR scans were conducted at inclusion and after 12 months of treatment. LA and LV measures, including volumes, ejection fraction, and peak systolic longitudinal strain were assessed using cine CMR feature tracking. T1 times were estimated using a previously validated modified look-locker inversion-recovery sequence. Commercially available software (Circle, Calgary, Canada) was used. All participants were followed for recurrences of AF, and all recurrences were documented with a standard 12-lead electrocardiogram. The associations between changes in mean volume, strain, and T1 times were examined using multivariable linear regression, adjusted for baseline age, sex, and AF type. Results LV post-contrast T1 time increased significantly in the SPL group (mean increase in SPL=1,97 ms [95% CI: 0,169; 3,323] vs. PL=0,21 ms [95% CI: −0,67; 1,11], p=0,027 for difference). However, the mean change of post-contrast LA T1 time did not differ between groups. LV peak longitudinal strain was also significantly improved in the SPL group (mean decrease in SPL: 19,82% [95% CI: −0,85; 40,48] vs. PL: 14,15% [95% CI: −36,21; 7,92], p=0,047). Similarly, LA stroke volume corrected for body surface area increased in the SPL-group (mean SPL: 34,33 ml/m2 [95% CI: −2,17; 42,62] vs. PL: 8,46 ml/m2 [95% CI: −20,13; 5,94], p=0,013). All changes remained significant after adjusting for age, sex and systolic blood pressure. No difference was found in arrhythmia burden between groups (P=0,89). Conclusion Low dose spironolactone may reduce the burden of diffuse myocardial fibrosis in AF. However, there was no reduction in the burden of arrhythmia. Acknowledgement/Funding Region of Southern Denmark, University of Southern Denmark, Danish Heart Association

scholarly journals Native T1 Mapping and Extracellular Volume Mapping for the Assessment of Diffuse Myocardial Fibrosis in Dilated Cardiomyopathy

2018 ◽  
Vol 11 (1) ◽  
pp. 48-59 ◽  
Author(s):  
Shiro Nakamori ◽  
Kaoru Dohi ◽  
Masaki Ishida ◽  
Yoshitaka Goto ◽  
Kyoko Imanaka-Yoshida ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Extracellular Volume ◽  
Diffuse Myocardial Fibrosis ◽  
Native T1

scholarly journals The link between left ventricular extracellular volume determined by T1 myocardial mapping and gut microbiota composition in individuals with heart failure and preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.N Kaburova ◽  
O.M Drapkina ◽  
S.M Uydin ◽  
M.V Vishnyakova ◽  
M.S Pokrovskaya ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Gut Microbiota ◽  
Myocardial Fibrosis ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Diffuse Myocardial Fibrosis ◽  
Rrna Gene ◽  
Preserved Ejection Fraction

Abstract Introduction Heart failure with preserved ejection fraction (HFpEF) represents a major challenge in modern cardiology. As described previously, in HFpEF comorbidities promote a systemic inflammatory state, leading to diffuse myocardial fibrosis resulting in myocardial stiffening. Gut dysbiosis which is considered as the novel source of chronic systemic inflammation has been actively investigated as the risk factor for the development and aggravation of cardiovascular diseases including heart failure. Cardiac magnetic resonance T1-mapping is a novel tool, which allows noninvasive quantification of the extracellular space and diffuse myocardial fibrosis. Moreover, the extracellular volume (ECV) fraction can be calculated, providing information on the relative expansion of the extracellular matrix, thus being a noninvasive alternative to myocardial biopsy studies. Purpose The research was aimed at investigating the correlation between the left ventricular ECV and gut microbial genera in patients with HFpEF. Methods 42 patients with confirmed HF-pEF (mediana and interquartile range of age 67 [64; 72] years, 47% men, body mass index &lt;35 kg/m2 with no history of myocardial infarction or diabetes mellitus) were enrolled in the study. The patients underwent transthoracic echocardiography with Doppler study, HF-pEF was confirmed according to the recent ESC guidelines (based on E/e' ratio, N-terminal pro-B type natriuretic peptide &gt;125 pg/ml and symptoms of heart failure). The intestinal microbiome was investigated using high-throughput sequencing of bacterial 16S rRNA gene. As the last step of research T1-myocardial mapping with the modified look-locker inversion-recovery protocol (MOLLI) sequence at 1.5 Tesla was performed to assess left ventricular extracellular volume fraction. Results The mean±std in ECV was 31.02±4.4%. The relative abundance (%) of the most prevalent phyla in gut microbiota was 48±22.5 for Firmicutes, 47.4±22.8 for Bacteroidetes and 1.5 [1.5; 2.5] for Proteobacteria. The analysis showed significant negative correlations between ECV and the following bacterial genera: Faecalibacterium (r=−0.35), Blautia (r=−0.43), Lachnoclostridium (r=−0.32). Moreover ECV positively correlated with Holdemania (r=0.4), Victivallis (r=0.38), Dehalobacterium (r=0.38), Enterococcus (r=0.33) and Catabacter (r=0.32). All correlation values with p&lt;0.05. Conclusion We discovered both negative and positive significant correlations between ECV – the non-invasive marker of myocardial fibrosis and several bacterial genera, which may have negative impact on myocardial remodeling in HF-pEF. Funding Acknowledgement Type of funding source: None

scholarly journals Cardiovascular magnetic resonance-determined left ventricular myocardium impairment is associated with C-reactive protein and ST2 in patients with paroxysmal atrial fibrillation

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Lei Zhao ◽  
Songnan Li ◽  
Chen Zhang ◽  
Jie Tian ◽  
Aijia Lu ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Healthy Subjects ◽  
T1 Mapping ◽  
Circumferential Strain ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Healthy Controls ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Native T1

Abstract Background Myocardial strain assessed with cardiovascular magnetic resonance (CMR) feature tracking can detect early left ventricular (LV) myocardial deformation quantitatively in patients with a variety of cardiovascular diseases, but this method has not yet been applied to quantify myocardial strain in patients with atrial fibrillation (AF) and no coexistent cardiovascular disease, i.e., the early stage of AF. This study sought to compare LV myocardial strain and T1 mapping indices in AF patients and healthy subjects, and to investigate the associations of a portfolio of inflammation, cardiac remodeling and fibrosis biomarkers with LV myocardial strain and T1 mapping indices in AF patients with no coexistent cardiovascular disease. Methods The study consisted of 80 patients with paroxysmal AF patients and no coexistent cardiovascular disease and 20 age- and sex-matched healthy controls. Left atrial volume (LAV), LV myocardial strain and native T1 were assessed with CMR, and compared between the AF patients and healthy subjects. Biomarkers of C-reactive protein (CRP), transforming growth factor beta-1 (TGF-β1), collagen III N-terminal propeptide (PIIINP), and soluble suppression of tumorigenicity 2 (sST2) were obtained with blood tests, and compared between the AF patients and healthy controls. Associations of these biomarkers with those CMR-measured parameters were analyzed for the AF patients. Results For the CMR-measured parameters, the AF patients showed significantly larger LAV and LV end-systolic volume, and higher native T1 than the healthy controls (max P = 0.027). The absolute values of the LV peak systolic circumferential strain and its rate as well as the LV diastolic circumferential strain rate were all significantly reduced in the AF patients (all P < 0.001). For the biomarkers, the AF patients showed significantly larger CRP (an inflammation biomarker) and sST2 (a myocardium stiffness biomarker) than the controls (max P = 0.007). In the AF patients, the five CMR-measured parameters of LAV, three LV strain indices and native T1 were all significantly associated with these two biomarkers of CRP and sST2 (max P = 0.020). Conclusions In patients with paroxysmal AF and no coexistent cardiovascular disease, LAV enlargement and LV myocardium abnormalities were detected by CMR, and these abnormalities were associated with biomarkers that reflect inflammation and myocardial stiffness.

scholarly journals Proteoglycan remodeling is accelerated in women with angina pectoris and diffuse myocardial fibrosis: the iPOWER Study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N.D Mygind ◽  
S Holm Nielsen ◽  
M Mide Michelsen ◽  
A Pena ◽  
D Bechsgaard Frestad ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Angina Pectoris ◽  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Obstructive Coronary Artery Disease ◽  
Extracellular Volume ◽  
Diffuse Myocardial Fibrosis ◽  
Public Institution ◽  
Funding Source

Abstract Background Women with angina and no obstructive coronary artery disease (CAD) have an unfavourable prognosis, possibly due to coronary microvascular disease and diffuse myocardial fibrosis (DMF). In DMF myocardial extracellular matrix (ECM) proteins are actively remodeled by matrix metalloproteinase (MMP). Purpose We investigated MMP-mediated degradation of the protegoglycans biglycan and versican in women with angina pectoris and possible DMF assessed by cardiac magnetic resonance T1 mapping. Methods Seventy-one women with angina pectoris and no obstructive CAD were included. Asymptomatic age-matched women served as controls (n=32). Versican and biglycan were measured in serum by specific competitive enzyme-linked immunosorbent assays. T1 mapping was performed by cardiac magnetic resonance with gadolinium measuring T1 and extracellular volume (ECV). Results Both biglycan and versican levels were higher in symptomatic women compared with controls; 31.4 ng/mL vs. 16.4 ng/mL (p&lt;0.001) and 2.1 ng/mL vs. 1.8 ng/mL (p&lt;0.001), respectively (Figure 1) and were moderately correlated to global ECV (r2=0.38, p&lt;0.001 and r2=0.26, p=0.015 respectively). Conclusion Turnover of biglycan and versican was increased in symptomatic compared to asymptomatic women and associated to ECV, supporting a link between angina with no obstructive CAD and fibrotic cardiac remodeling. The examined biomarkers may prove to be suitable for monitoring active ECM remodeling. Figure 1. Levels of BGM and VCANM Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): This work was supported by The Danish Heart Foundation, the Danish Research Fund (Den Danske Forskningsfond) and by University of Copenhagen.

scholarly journals T1 and T2 Mapping in Cardiology: “Mapping the Obscure Object of Desire”

Cardiology ◽  
2017 ◽  
Vol 138 (4) ◽  
pp. 207-217 ◽  
Author(s):  
Sophie Mavrogeni ◽  
Dimitris Apostolou ◽  
Panayiotis Argyriou ◽  
Stella Velitsista ◽  
Lilika Papa ◽  
...  
Keyword(s):  
Heart Failure ◽  
T1 Mapping ◽  
Clinical Decision Making ◽  
Volume Fraction ◽  
T2 Mapping ◽  
Extracellular Volume ◽  
Diffuse Fibrosis ◽  
Post Contrast ◽  
Cardiac Amyloid ◽  
Native T1

The increasing use of cardiovascular magnetic resonance (CMR) is based on its capability to perform biventricular function assessment and tissue characterization without radiation and with high reproducibility. The use of late gadolinium enhancement (LGE) gave the potential of non-invasive biopsy for fibrosis quantification. However, LGE is unable to detect diffuse myocardial disease. Native T1 mapping and extracellular volume fraction (ECV) provide knowledge about pathologies affecting both the myocardium and interstitium that is otherwise difficult to identify. Changes of myocardial native T1 reflect cardiac diseases (acute coronary syndromes, infarction, myocarditis, and diffuse fibrosis, all with high T1) and systemic diseases such as cardiac amyloid (high T1), Anderson-Fabry disease (low T1), and siderosis (low T1). The ECV, an index generated by native and post-contrast T1 mapping, measures the cellular and extracellular interstitial matrix (ECM) compartments. This myocyte-ECM dichotomy has important implications for identifying specific therapeutic targets of great value for heart failure treatment. On the other hand, T2 mapping is superior compared with myocardial T1 and ECM for assessing the activity of myocarditis in recent-onset heart failure. Although these indices can significantly affect the clinical decision making, multicentre studies and a community-wide approach (including MRI vendors, funding, software, contrast agent manufacturers, and clinicians) are still missing.

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