Abstract 15126: Myocardial Tissue Reverse Remodeling After Guideline-directed Medical Therapy in Idiopathic Dilated Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Pengfei Yue ◽  
Yuanwei Xu ◽  
Yangjie Li ◽  
Xiaoyue Zhou ◽  
Yucheng Chen
Keyword(s):  
Dilated Cardiomyopathy ◽  
Medical Therapy ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Reverse Remodeling ◽  
Myocardial Tissue ◽  
Native T1 ◽  
Tissue Characteristics ◽  
Cell Volumes

Background: The prognosis of idiopathic dilated cardiomyopathy (DCM) patients has improved remarkably in the recent decades with guideline-directed medical therapy (GDMT) and some patients undergo left ventricular reverse remodeling (LVRR). Objectives: We aim to study the dynamic changes of myocardial tissue characteristics by cardiovascular magnetic resonance (CMR), and investigate the association between myocardial tissue characteristics and cardiac functional remodeling in DCM patients after treatment. Methods: A total of 133 prospectively and consecutively enrolled DCM patients underwent baseline and follow-up CMR examinations with a median interval of 13.7 months (IQR: 12.2-18.5 months). The CMR protocol included cine, late gadolinium enhancement (LGE), pre- and post-contrast T1, and T2 mapping. LVRR was defined as an absolute increase in LV ejection fraction (EF) of >10% to a final value of ≥ 35% with a relative decrease in LV end-diastolic volume (EDV) of >10%. Results: Forty-two (31.6%) patients experienced LVRR during follow-up. At baseline, new onset heart failure, lower LVEF and the absence of LGE were independent predictors of LVRR. Patients with LVRR showed significant decrease of myocardial native T1, indexed matrix and cell volumes, while patients without LVRR also showed significant albeit smaller decrease of native T1 and indexed matrix and cell volumes. The changes of myocardial tissue characteristics were significantly correlated with the improvement of LVEF and indexed LVEDV. Conclusions: In idiopathic DCM patients, significant improvements in myocardial tissue characteristics were observed and accompanied with the improvement in LVEF and reduction in indexed LVEDV after GDMT.

scholarly journals Myocardial Tissue Reverse Remodeling after Guideline-directed Medical Therapy in Idiopathic Dilated Cardiomyopathy

2020 ◽  
Author(s):  
Yuanwei Xu ◽  
Weihao Li ◽  
Ke Wan ◽  
Yaodan Liang ◽  
Xincheng Jiang ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Dilated Cardiomyopathy ◽  
Medical Therapy ◽  
Left Ventricular ◽  
T Test ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Reverse Remodeling ◽  
Absolute Increase ◽  
Significant Difference

Background - The prognosis of idiopathic dilated cardiomyopathy (DCM) patients has improved remarkably in recent decades with guideline-directed medical therapy (GDMT). Left ventricular reverse remodeling (LVRR) is one of the major therapeutic goals. Whether myocardial fibrosis or inflammation would reverse associated with LVRR remains unknown. Methods - A total of 157 prospectively enrolled DCM patients underwent baseline and follow-up CMR examinations with a median interval of 13.7 months (interquartile range: 12.2-18.5 months). LVRR was defined as an absolute increase in LV ejection fraction (LVEF) of >10% to the final value of ≥ 35% and a relative decrease in LV end-diastolic volume (EDV) of >10%. Statistical analyses were performed using paired t-test and student t-test, logistic regression analysis, and linear regression analysis. Results - Forty-eight (31%) patients reached LVRR. At baseline, younger age, worse NYHA class, new-onset heart failure, lower LVEF, absence of late gadolinium enhancement (LGE), lower myocardial T2, and extracellular volume (ECV) were significant predictors of LVRR. During the follow-up, patients with and without LVRR both showed a significant decrease of myocardial native T1 (LVRR: [baseline]1303.0±43.6ms; [follow-up]1244.7±51.8ms; without LVRR: [baseline]1308.5±80.5ms; [follow-up]1287.6±74.9ms, both p < 0.001), matrix and cellular volumes while no significant difference was observed in T2 or ECV values after treatment. Conclusions - In idiopathic DCM patients, the absence of LGE, lower T2, and ECV values at baseline are significant predictors of LVRR. The myocardial T1, matrix, and cell volume decrease significantly in patients with LVRR after GDMT.

scholarly journals Feature-tracking cardiac magnetic resonance left ventricular global longitudinal strain improves 6 months after kidney transplantation associated with reverse remodeling, not myocardial tissue characteristics

2021 ◽  
Author(s):  
Maurício Fregonesi Barbosa ◽  
Mariana Moraes Contti ◽  
Luis Gustavo Modelli de Andrade ◽  
Alejandra del Carmen Villanueva Mauricio ◽  
Sergio Marrone Ribeiro ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Cardiac Magnetic Resonance ◽  
Feature Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Myocardial Tissue ◽  
Tissue Characteristics

AbstractTo determine whether left ventricular (LV) global longitudinal strain (GLS) measured by feature-tracking (FT) cardiac magnetic resonance (CMR) improves after kidney transplantation (KT) and to analyze associations between LV GLS, reverse remodeling and myocardial tissue characteristics. This is a prospective single-center cohort study of kidney transplant recipients who underwent two CMR examinations in a 3T scanner, including cines, tagging, T1 and T2 mapping. The baseline exam was done up to 10 days after transplantation and the follow-up after 6 months. Age and sex-matched healthy controls were also studied for comparison. A total of 44 patients [mean age 50 ± 11 years-old, 27 (61.4%) male] completed the two CMR exams. LV GLS improved from − 13.4% ± 3.0 at baseline to − 15.2% ± 2.7 at follow-up (p < 0.001), but remained impaired when compared with controls (− 17.7% ± 1.5, p = 0.007). We observed significant correlation between improvement in LV GLS with reductions of left ventricular mass index (r = 0.356, p = 0.018). Improvement in LV GLS paralleled improvements in LV stroke volume index (r = − 0.429, p = 0.004), ejection fraction (r = − 0.408, p = 0.006), global circumferential strain (r = 0.420, p = 0.004) and global radial strain (r = − 0.530, p = 0.002). There were no significant correlations between LV GLS, native T1 or T2 measurements (p > 0.05). In this study, we demonstrated that LV GLS measured by FT-CMR improves 6 months after KT in association with reverse remodeling, but not native T1 or T2 measurements.

P337Natural history, reversibility and arrhythmias associated with truncating titin variants in dilated cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C R Vissing ◽  
T B Rasmussen ◽  
M S Olesen ◽  
L N Pedersen ◽  
A Dybro ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Medical Therapy ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Absolute Increase ◽  
The Mean

Abstract Background Truncating genetic variants in titin (TTNtv) are identified in 15–25% of patients with primary dilated cardiomyopathy (DCM). Previous genotype/phenotype studies have reported conflicting results regarding disease severity and pathologic features associated with TTNtv. Purpose To investigate the natural history, reversibility and burden of arrhythmias associated with TTNtv in a Danish cohort with long-term follow-up. Methods Patients with DCM, recruited from two Danish tertiary centers, were included based on the presence of a TTNtv in a cardiac expressed titin exon. Data on patients' medical history including symptoms, demography, family history, comorbidities, treatment, ECG features, and echocardiograms were registered. Outcome data including all-cause mortality, need of heart transplantation (HTX) or left ventricular assist device (LVAD), and presence of ventricular and supraventricular arrhythmias were registered. Left ventricular reverse remodeling (LVRR) was defined as an absolute increase in left ventricular ejection fraction (LVEF) ≥10% points or normalization. Results A total of 104 patients (71 men, 69%; 72 probands) with definite TTNtv-DCM were included. The mean age at DCM diagnosis was (mean±SD) 45±13 years (43±13 for men; 49±14 for women, p<0.04) and median follow-up was 8.1 years. The mean LVEF was 28±13% at time of diagnosis (26±12% for men; 30±13% for women, p=0.173). During follow-up, 31 patients (30%; 24 men) died or needed HTX/LVAD. Medical therapy was associated with LVRR in 79% of patients 3.6 years after diagnosis. LVRR was maintained long-term in 64% of patients. Women had a better response to medical therapy compared to men (mean LVEF increase 19%; vs 15% in men, p<0.04). Atrial fibrillation/flutter was observed in 40% of patients and ventricular arrhythmias in 23% of patients. Men had an earlier occurrence of both supraventricular and ventricular arrhythmias (p=0.005) with half of the men having experienced an arrhythmia at the age of 54 years. Freedom from arrhythmias with age Conclusion TTNtv leads to a DCM phenotype associated with a marked gender-difference in age at DCM diagnosis and high burden of both supraventricular and ventricular arrhythmias. Importantly, the DCM-TTNtv phenotype was associated with a high degree of reversibility of systolic function following medical therapy.

scholarly journals Feature-Tracking Left Ventricular Global Longitudinal Strain Improves 6 Months After Kidney Transplantation Associated With Reverse Remodeling, Not Myocardial Tissue Characteristics

2021 ◽  
Author(s):  
Maurício Fregonesi Barbosa ◽  
Mariana Moraes Contti ◽  
Luis Gustavo Modelli de Andrade ◽  
Alejandra del Carmen Villanueva Mauricio ◽  
Sergio Marrone Ribeiro ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Feature Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Volume Index ◽  
Reverse Remodeling ◽  
Myocardial Tissue ◽  
Native T1

Abstract PurposeTo determine whether left ventricular (LV) global longitudinal strain (GLS) measured by feature-tracking (FT) cardiac magnetic resonance (CMR) improves after kidney transplantation (KT) and to analyze associations between LV GLS, reverse remodeling, and myocardial tissue characteristics.MethodsThis is a prospective single-center cohort study of kidney transplant recipients who underwent two CMR examinations in a 3T scanner, including cines, tagging, T1 and T2 mapping. The baseline exam was done until 10 days after transplantation and the follow-up after 6 months. Age and sex-matched healthy controls were also studied for comparison. ResultsA total of 44 patients (mean age 50 ± 11 years-old, 27 (61.4%) male) completed the two CMR exams. LV GLS improved from -13.4% +/- 3.0 at baseline to -15.2% +/- 2.7 at follow-up (p < 0.001), but remained impaired when compared with controls (-17.7% +/- 1.5, p = 0.007). We observed significant correlation between improvement in LV GLS with reductions of left ventricular mass index (r = 0.356, p= 0.018). Improvement in LV GLS paralleled improvements in LV stroke volume index (r = -0.429, p = 0.004), ejection fraction (r = -0.408, p = 0.006), global circumferential strain (r = 0.420, p = 0.004) and global radial strain (r = -0.530, p = 0.002). There were no significant correlations between LV GLS, native T1 or T2 measurements (p > 0.05). ConclusionIn this study, we demonstrated that LV GLS measured by FT-CMR improves 6 months after KT in association with reverse remodeling, but not native T1 or T2 measurements.

Abstract 14182: Myocardial Fibrosis and Reverse Remodelling in Nonischaemic Dilated Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Andrea Barison ◽  
Alessandro Ortalda ◽  
Giancarlo Todiere ◽  
Giuseppe Vergaro ◽  
Gianluca Mirizzi ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Dilated Cardiomyopathy ◽  
Myocardial Fibrosis ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Post Contrast ◽  
Reverse Remodelling ◽  
Lv Volumes ◽  
Lv Ejection Fraction

Introduction: In nonischaemic dilated cardiomyopathy (NICM), myocardial fibrosis can be detected by cardiovascular magnetic resonance (CMR) as late gadolinium enhancement (LGE) and is associated with worse prognosis. Hypothesis: Absence of myocardial fibrosis is associated with left ventricular reverse remodelling (LV-RR). Methods: One-hundred-and-twenty-five NICM patients (age 51±16 years, 82 male) were enrolled and underwent baseline CMR; patients with ischaemic, valvular, congenital heart disease, other cardiomyopathies or contraindications to CMR were excluded. After a 24-month follow-up on optimal medical therapy, all patients underwent a second CMR; patients who died, underwent device implantation or declined a second CMR, were also excluded from the study. LGE was quantified on post-contrast CMR images. LV-RR was defined as an increase in LV ejection fraction ≥10 U or decrease in LV end-diastolic volume ≥10% at follow-up. Results: Mean LV ejection fraction was 41±11% at baseline, 47±12% at follow-up: LV-RR was observed in 59 patients (47%), with no age or gender difference (p=NS) . LGE was present in 69 (54%) patients at baseline (mean extent 12±6 g), without significant differences at follow-up (mean extent 13±7 g). Patients experiencing LV-RR during follow-up presented a baseline worse LV ejection fraction (36±12%) than no-LV-RR patients ( 45±9%, p<0.01), greater LV volumes (123±38 vs. 110±22 ml/m2, p=0.02) and worse right ventricular ejection fraction (54±12% vs. 59±10%, p=0.02) . Nevertheless, only 17 (29%) LV-RR patients presented LGE compared to 31 (47%, p=0.04) no-LV-RR patients. Moreover, among LGE-positive patients (n=48), only 17 (35%) developed LV-RR, while among LGE-negative patients (n=77), 42 (55%) developed LV-RR (p=0.04). Multivariate regression analysis showed that the absence of LGE at baseline CMR was a strong predictor of LV-RR (p=0.02), even after correction for age, New York Heart Association class, LV volumes and systolic function. Conclusions: In patients with idiopathic dilated cardiomyopathy, absence of LGE was a strong independent predictor of LV-RR at 2-year follow-up, irrespective of the initial clinical status and the severity of ventricular dilatation and dysfunction.

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