Comparing CMR Mapping Methods and Myocardial Patterns Toward Heart Failure Outcomes in Nonischemic Dilated Cardiomyopathy

Vita, Tomás; Gräni, Christoph; Abbasi, Siddique; Neilan, Tomas G.; Rowin, Ethan J.; Kaneko, Kensuke; Coelho‐Filho, Otávio R.; Watanabe, Eri; Mongeon, François‐Pierre; Farhad, Hoshang; Rassi, Carlos Henrique Reis Esselin; Choi, Yuna L.; Cheng, Kathleen; Givertz, Michael M.; Blankstein, Ron; Steigner, Michael L.; Aghayev, Ayaz; Jerosch‐Herold, Michael; Kwong, Raymond Y.

doi:10.1016/j.jcmg.2018.08.021

Cited by 90 publications

(43 citation statements)

References 25 publications

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“…While biopsy remains the gold standard in assessing myocardial fibrosis, such an invasive procedure is not feasible for a large clinical study. Therefore, a non-invasive alternative such as ECV has drawn clinical interest and is regarded as a surrogate for interstitial fibrosis [ 1 , 2 , 12 ]. A few small studies that investigated relationships between strain and ECV [ 10 , 11 , 13 , 14 ] yielded mixed findings largely due to small sample size and/or narrow span of ECV distribution.…”

Section: Discussionmentioning

confidence: 99%

The association of reduced left ventricular strains with increased extracellular volume and their collective impact on clinical outcomes

Jin

Weber

Singh

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Myocardial fibrosis and left ventricular (LV) longitudinal strain are independently associated with adverse clinical outcomes. However, the relationship between tissue properties and strain indices as well as their collective impact on outcomes are yet to be fully elucidated. We aim to investigate the relationship between LV global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) with extracellular volume (ECV) and their collective impact. Methods Consecutive patients referred for clinical cardiovascular magnetic resonance (CMR) due to cardiomyopathy were prospectively enrolled. All patients underwent CMR with T1 mapping. ECV was calculated incorporating native and post-contrast T1 as well as hematocrit. LV GLS, GCS, and GRS were assessed by feature tracking. Hazard ratios and Kaplan–Meier curves were produced to assess the association between strains and T1 mapping indices with a composite outcome of all-cause mortality and hospitalized heart failure. Results The study consisted of 259 patients with mixed referring diagnoses of non-ischemic/ischemic cardiomyopathy and 21 normal controls. Decreased GLS, GCS and GRS were associated with increased ECV, increased native T1, and reduced post-contrast T1 in a dose dependent manner when T1 or ECV was in the abnormal range. After a mean follow-up of 31 ± 23 months, 41 events occurred including 37 heart failure admissions and 4 deaths. Kaplan–Meier plots demonstrated that reduced strains were associated with reduced event-free survival predominantly in patients with increased ECV (≥ 28.3%). The worst outcome was among those with both reduced strains and increased ECV. In the multivariable models, increased ECV, reduced post-contrast T1 and reduced strains in all 3 directions remained predictors of outcome risk, respectively. Conclusion Our findings highlight the intrinsic link between altered CMR tissue properties and impaired myocardial mechanical performance and additionally demonstrate improved risk stratification by characterizing tissue property among patients with reduced strain.

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Section: Discussionmentioning

confidence: 99%

The association of reduced left ventricular strains with increased extracellular volume and their collective impact on clinical outcomes

Jin

Weber

Singh

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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“…Changes in ECV are hypothesized to be reflective of changes in the interstitial space, and increased extracellular volume is associated with diffuse myocardial fibrosis [38]. Recently, it has been investigated to specifically examine its predictive value in NIDCM patients with comparison to LGE, where there remains an unmet need for accurate risk stratification [39]. The single-center study involved 240 NIDCM patients and assessed the correlation of their ECV overall, as well as correlation with specific cardio-anatomic locations, to a primary end point comprised of major adverse cardiac events (MACE), such as death from any cause or heart failure hospitalization.…”

Section: Extracellular Volume Fraction Measurements In Dcmmentioning

confidence: 99%

Cardiac Mri in Cardiomyopathies

et al. 2021

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Heart failure affects 1–2% of the adult population and one of the main contributors to its development is cardiomyopathy. Assessing a patient's risk for adverse events in heart failure is challenging and made more difficult by the heterogenous phenotypic expression of the disease. Cardiac MRI has long been a gold standard measure of myocardial function and anatomy due to its high spatial and temporal resolution. More recently, it has been posited to play a more critical role in the diagnosis and prognosis of cardiomyopathy-related heart failure. Given the limitations of more commonly used imaging modalities, increasing the clinical use of cardiac magnetic resonance imaging could potentially improve the prognosis of specific subgroups of patients at risk of adverse cardiac events.

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“…They concluded that ECV was significantly higher for the septum compared to the nonseptal myocardium in normal controls. Recently, Vita et al demonstrated that ECV varies according to the myocardial region in patients with non-ischemic dilated cardiomyopathy 17 . In this study, we further demonstrated that this interregional variation of ECV was more significant in the patient group than the control group and was positively associated with the corresponding regional wall thickness.…”

Section: Discussionmentioning

confidence: 99%

CMR-derived ECVs vary with myocardial region and associate with the regional wall thickness

Hou

Liu

et al. 2020

Sci Rep

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This study was designed to identify whether the position and size of the region of interest (ROI) influence extracellular volume fraction (ECV) measurements. Patients with localized (n = 203) or infiltrative (n = 215) cardiomyopathies and 36 normal controls were enrolled in this study. ECV measurements at 4 different regions, including the anterior, septal, posterior and lateral wall regions, were measured, and all groups were compared. Regional ECV was correlated with the corresponding regional wall thickness. The diagnostic power to differentiate the myocardial abnormalities was evaluated for each myocardial region. ECVs measured using five different ROI sizes within each myocardial region were compared. Our results showed that ECVs varied among the myocardial regions, and this variation was significantly associated with regional wall thicknesses. For the detection of myocardial abnormalities, regional ECV revealed similar results as ECV derived from the whole region except for the anterior region. No significant difference was found in the ECVs measured using the five different ROI sizes. In conclusion, CMR-derived ECVs vary with myocardial region, and this variation is significantly associated with the regional wall thickness. In contrast, the measured size of the ROI has less of an effect on the ECV.

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Comparing CMR Mapping Methods and Myocardial Patterns Toward Heart Failure Outcomes in Nonischemic Dilated Cardiomyopathy

Cited by 90 publications

References 25 publications

The association of reduced left ventricular strains with increased extracellular volume and their collective impact on clinical outcomes

The association of reduced left ventricular strains with increased extracellular volume and their collective impact on clinical outcomes

Cardiac Mri in Cardiomyopathies

CMR-derived ECVs vary with myocardial region and associate with the regional wall thickness

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