Probing the intravascular and interstitial compartments of remodeled myocardium in heart failure patients with preserved and reduced ejection fraction: a CMR study.

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License: CC BY 4.0
Serval ID
serval:BIB_0E4AD777E62B
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Probing the intravascular and interstitial compartments of remodeled myocardium in heart failure patients with preserved and reduced ejection fraction: a CMR study.
Journal
BMC medical imaging
Author(s)
Masci P.G., Pavon A.G., Berchier G., Schwitter J.
ISSN
1471-2342 (Electronic)
ISSN-L
1471-2342
Publication state
Published
Issued date
05/01/2019
Peer-reviewed
Oui
Volume
19
Number
1
Pages
1
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
Recent autopsy studies found microvascular rarefaction in remodeled myocardium of patients who died of heart failure with preserved ejection-fraction (HFpEF). This condition has not been investigated so far by non-invasive methods in patients with HFpEF. The aim was to quantify the intravascular volume (IVV) compartment by CMR in HFpEF patients.
In two separate CMR examinations, HFpEF patients (n = 6; 12 examinations) and post-myocardial infarction patients (post-MI; n = 6; 12 examinations) were studied with T <sub>1</sub> -mapping (MOLLI-sequence) before and after IV bolus of 0.03 mmol/Kg of the intravascular contrast-medium (CM) Gadofosveset and 0.2 mmol/Kg of the extravascular CM Gadobutrol yielding IVV and extracellular volume (ECV), respectively. Healthy controls (n = 10 with Gadofosveset only, n = 10 with Gadobutrol only) were also studied with the same protocol. IVV and ECV were measured in the basal septum (without ischemic scar in post-MI patients). In post-MI patients, ECV and IVV were also measured in the ischemic scar. Left ventricular (LV) volumes, mass, and ejection-fraction were measured by standard protocol. LV global longitudinal strain (GLS) was calculated by feature tracking on long-axis cine acquisitions.
LV mass to end-diastolic volume ratio and GLS in HFpEF were higher and lower, respectively, than in healthy controls and post-MI patients, whereas the post-MI patients showed lower LV ejection-fraction. Compared to healthy myocardium of controls, IVV in scar was reduced (0.135 ± 0.018 vs 0.109 ± 0.008, respectively, p = 0.005), while ECV was increased (0.244 ± 0.037 vs 0.698 ± 0.106, respectively, p < 0.001). However, IVV did not differ among HFpEF, post-MI, and healthy controls (0.155 ± 0.033, 0.146 ± 0.038, and 0.135 ± 0.018, respectively, p = 0.413), whereas ECV was higher in HFpEF than in post-MI and healthy controls (0.304 ± 0.159, 0.270 ± 0.017, and 0.244 ± 0.037, respectively, p = 0.003).
The T <sub>1</sub> -mapping technique combined with an intravascular CM shows potential to measure IVV. In infarct scar with substantially increased ECV, IVV was significantly reduced. Unlike in infarct scar, in remodeled myocardium of HFpEF patients, increased ECV was not accompanied by a reduction of IVV.
Keywords
Adult, Aged, Autopsy, Case-Control Studies, Female, Heart Failure/diagnostic imaging, Heart Failure/physiopathology, Humans, Magnetic Resonance Imaging, Cine/methods, Male, Microvascular Rarefaction/diagnostic imaging, Middle Aged, Stroke Volume, Ventricular Remodeling, Young Adult
Pubmed
Web of science
Open Access
Yes
Create date
20/01/2019 15:08
Last modification date
20/08/2019 12:35
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