Comprehensive MRI analysis of early cardiac and vascular remodeling in middle-aged patients with abdominal obesity

Mandry, Damien; Eschalier, Romain; Kearney‐Schwartz, Anna; Rossignol, Patrick; Joly, Laure; Djaballah, W.; Böhme, Philip; Escanyé, Jean Marie; Vuissoz, Pierre A.; Fay, Renaud; Zannad, Faı̈ez; Marié, Pierre

doi:10.1097/hjh.0b013e32834f6f3f

Cited by 19 publications

(43 citation statements)

References 39 publications

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“…Forth, TAC is a crude indicator of global arterial stiffness based on a modified two-factor Windkessel model combining resistance and capacitance. As such, TAC is limited in describing all components of arterial mechanics [40]. Finally, there were limitations of our 2D phase contrast sequence used to calculate PWV and AD.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular outcome associations among cardiovascular magnetic resonance measures of arterial stiffness: the Dallas heart study

Maroules

Khera²,

Ayers

et al. 2014

Journal of Cardiovascular Magnetic Resonance

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BackgroundCardiovascular magnetic resonance (CMR) has been validated for the noninvasive assessment of total arterial compliance and aortic stiffness, but their associations with cardiovascular outcomes is unknown. The purpose of this study was to evaluate associations of CMR measures of total arterial compliance and two CMR measures of aortic stiffness with respect to future cardiovascular events.MethodsThe study consisted of 2122 Dallas Heart Study participants without cardiovascular disease who underwent CMR at 1.5 Tesla. Aortic stiffness was measured by CMR-derived ascending aortic distensibility and aortic arch pulse wave velocity. Total arterial compliance was calculated by dividing left ventricular stroke volume by pulse pressure. Participants were monitored for cardiovascular death, non-fatal cardiac events, and non-fatal extra-cardiac vascular events over 7.8 ± 1.5 years. Cox proportional hazards regression was used to assess for associations between CMR measures and cardiovascular events.ResultsAge, systolic blood pressure, and resting heart rate were independently associated with changes in ascending aortic distensibility, arch pulse wave velocity, and total arterial compliance (all p < .0001). A total of 153 participants (6.9%) experienced a cardiovascular event. After adjusting for traditional risk factors, total arterial compliance was modestly associated with increased risk for composite events (HR 1.07 per 1SD, p = 0.03) while the association between ascending aortic distensibility and composite events trended towards significance (HR 1.18 per 1SD, p = 0.08). Total arterial compliance and aortic distensibility were independently associated with nonfatal cardiac events (HR 1.11 per 1SD, p = 0.001 and HR 1.45 per 1SD, p = 0.0005, respectively), but not with cardiovascular death or nonfatal extra-cardiac vascular events. Arch pulse wave velocity was independently associated with nonfatal extra-cardiac vascular events (HR 1.18 per 1SD, p = 0.04) but not with cardiovascular death or nonfatal cardiac events.ConclusionsIn a multiethnic population free of cardiovascular disease, CMR measures of arterial stiffness are associated with future cardiovascular events. Total arterial compliance and aortic distensibility may be stronger predictors of nonfatal cardiac events, while pulse wave velocity may be a stronger predictor of nonfatal extra-cardiac vascular events.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular outcome associations among cardiovascular magnetic resonance measures of arterial stiffness: the Dallas heart study

Maroules

Khera²,

Ayers

et al. 2014

Journal of Cardiovascular Magnetic Resonance

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“…Each plane was recorded as previously detailed [8, 9, 16], and LV end-diastolic volume (EDV), end-systolic volume and ejection fraction (EF) were obtained by an expert cardiologist, using dedicated software (MASS research v2013-exp™, Medis, Leiden University Medical Center, The Netherlands). Main acquisition parameters were as follows: 8 mm slice-thickness, 3.5–3.9 ms repetition time, 14 to 16 K-space lines per segment, 1.5 ASSET factor, 30 phases per cardiac cycle with view sharing, field-of-view (FOV) ranging from 32 to 38 cm with a phase FOV of 0.9, and a 224x224 matrix interpolated to 256x256.…”

Section: Methodsmentioning

confidence: 99%

“…The combined analysis of brachial blood pressure (BP) and of the SV producing the BP wave has been recently shown to significantly improve the CMR characterization of LV remodeling in hypertensive patients [8, 9]. This improvement is notably due to the precise information obtained on LV loading conditions with the non-invasive determination of various parameters such as total peripheral vascular resistance, total arterial compliance index and effective arterial elastance [8–13].…”

Section: Introductionmentioning

confidence: 99%

“…This improvement is notably due to the precise information obtained on LV loading conditions with the non-invasive determination of various parameters such as total peripheral vascular resistance, total arterial compliance index and effective arterial elastance [8–13]. However, this vascular monitoring has yet to be investigated in the context of LV remodeling following reperfused acute MI and where patients are commonly referred to hypotensive medical regimens (angiotensin converting enzyme (ACE) inhibitors, beta-blockers).…”

Section: Introductionmentioning

confidence: 99%

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Cardiac remodeling following reperfused acute myocardial infarction is linked to the concomitant evolution of vascular function as assessed by cardiovascular magnetic resonance

Huttin

Mandry

Eschalier

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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BackgroundLeft ventricular (LV) remodeling following acute myocardial infarction (MI) is difficult to predict at an individual level although a possible interfering role of vascular function has yet to be considered to date. This study aimed to determine the extent to which this LV remodeling is influenced by the concomitant evolution of vascular function and LV loading conditions, as assessed by phase-contrast Cardiovascular Magnetic Resonance (CMR) of the ascending aorta.MethodsCMR was performed in 121 patients, 2–4 days after reperfusion of a first ST-segment elevation myocardial infarction and 6 months thereafter. LV remodeling was: (i) assessed by the 6-month increase in end-diastolic volume (EDV) and/or ejection fraction (EF) and (ii) correlated with the indexed aortic stroke volume (mL.m−2), determined by a CMR phase-contrast sequence, along with derived functional vascular parameters (total peripheral vascular resistance (TPVR), total arterial compliance index, effective arterial elastance).ResultsAt 6 months, most patients were under angiotensin enzyme converting inhibitors (86%) and beta-blockers (84%) and, on average, all functional vascular parameters were improved whereas blood pressure levels were not. An increase in EDV only (EDV+/EF-) was documented in 17% of patients at 6 months, in EF only (EDV-/EF+) in 31%, in both EDV and EF (EDV+/EF+) in 12% and neither EDV nor EF (EDV-/EF-) in 40%. The increase in EF was mainly and independently linked to a concomitant decline in TPVR (6-month change in mmHg.min.m2.L−1, EDV-/EF-: +1 ± 8, EDV+/EF-: +3 ± 9, EDV-/EF+: -7 ± 6, EDV+/EF+: -15 ± 20, p < 0.001) while the absence of any EF improvement was associated with high persisting rates of abnormally high TPVR at 6 months (EDV-/EF-: 31%, EDV+/EF-: 38%, EDV-/EF+: 5%, EDV+/EF+: 13%, p = 0.007). By contrast, the 6–month increase in EDV was mainly dependent on cardiac as opposed to vascular parameters and particularly on the presence of microvascular obstruction at baseline (EDV-/EF-: 37%, EDV+/EF-: 76%, EDV-/EF+: 38%, EDV+/EF+: 73%, p = 0.003).ConclusionLV remodeling following reperfused MI is strongly influenced by the variable decrease in systemic vascular resistance under standard care vasodilating medication. The CMR monitoring of vascular resistance may help to tailor these medications for improving vascular resistance and consequently, LV ejection fraction.Trial registration NCT01109225 on ClinicalTrials.gov site (April, 2010).

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“…Furthermore, we previously described thanks to an MRI substudy that there was no difference in aortic PWV between controls and patients with AO. 39 We may hypothesize that arterial changes may not have occurred yet in the subjects we have investigated, who were young and normotensives. Circulating collagen peptides are not specific to cardiac tissue, but previous histological studies observed a significant correlation between collagen peptides serum concentrations and cardiac fibrosis.…”

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confidence: 95%

Features of Cardiac Remodeling, Associated With Blood Pressure and Fibrosis Biomarkers, Are Frequent in Subjects With Abdominal Obesity

et al. 2014

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White subjects with AO (waist circumference >94 cm for men and >80 cm for women) 2 aged 40 to 65 years and age-and sex-matched healthyAbstract-Incidence and prevalence of abdominal obesity (AO) are growing exponentially. Subjects with AO are at higher risk of developing heart failure. The purpose of the study was to investigate early changes in cardiac and arterial structure and function and extracellular matrix biomarkers in normotensive healthy subjects with AO. Subjects with AO and age-and sex-matched controls underwent echocardiography, MRI (cardiac remodeling index), carotid intima-media thickness, pulse wave velocity, and blood fibrosis biomarkers measurements. We enrolled 87 subjects with AO and 53 controls. Although normotensive, subjects with AO had higher systolic blood pressure (BP; 122±11 versus 116±11 mm Hg; P=0.003), left ventricular mass (94±24 versus 84±21 g; P=0.034), and cardiac remodeling index (0.67±0.16 versus 0.60±0.10 g/mL; P=0.026) but unchanged carotid intima-media thickness and pulse wave velocity. Diastolic dysfunction (E′ <10 cm/s) could be detected in 38% of subjects with AO (4% in controls). Left ventricular remodeling, as assessed by cardiac remodeling index, was positively and independently associated with higher BP (systolic BP and mean arterial pressure but not diastolic BP) and AO. Higher BP, AO, and procollagen-III-N-terminal peptide (≥2.4 ng/mL) concentrations (odds ratio, 4.15 [1.42-12.2]; P=0.01) were positively associated with diastolic dysfunction. Early cardiac structural remodeling, fibrosis, and diastolic dysfunction were detectable in healthy subjects with AO. Higher BP, procollagen-III-N-terminal peptide, and AO were independently associated with early cardiac structural and functional changes. It is to be investigated whether in subjects with AO, an early BP reduction, even if normotensive, combined with weight loss may avoid adverse cardiac remodeling and protect against progression to heart failure. From the INSERM, Center d'Investigation Clinique CIC-P 9501, Nancy, France (R.E., P.R., A.K.S., C.A., K.K., R.F., F.Z.); CHU-Nancy, Department of Cardiology, Nancy, France (F.Z.); Université de Lorraine, Nancy, France (P.R., D.M., P.Y.M., F.Z.); INSERM, U1116, Nancy, France (P.R., P.Y.M., F.Z.); Clermont Université, Université d'Auvergne, UMR6284, Clermont-Ferrand, France (R.E.); CHU Clermont-Ferrand, Department of Cardiology, ClermontFerrand, France (R.E.); CHU-Nancy, Department of Radiology, Nancy, France (D.M.); CHU-Nancy, Department of Nuclear Medicine, Nancy, France (P.Y.M.); and INSERM, U947, Nancy, France (D.M. Metabolic PhenotypingBlood was sampled between 8 and 10 am after maintaining a supine position for 30 minutes and the following were assessed: fasting glucose, oral glucose tolerance test (to exclude patients with diabetes mellitus), glycohemoglobin, serum creatinine (estimated glomerular filtration rate by the MDRD [Modification of the Diet in Renal Disease] formula), 9 ultrasensitive C-reactive protein, alanine aminotransferase, lipid profile, leptin, ...

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Comprehensive MRI analysis of early cardiac and vascular remodeling in middle-aged patients with abdominal obesity

Abstract: Concentric remodeling is frequently documented by MRI in the middle-aged men with abdominal obesity and in association with a decrease in TAC no longer counter-balanced by a decrease in TPVR, suggesting a remodeling from proximal to peripheral vasculature.

Cited by 19 publications

References 39 publications

Cardiovascular outcome associations among cardiovascular magnetic resonance measures of arterial stiffness: the Dallas heart study

Cardiovascular outcome associations among cardiovascular magnetic resonance measures of arterial stiffness: the Dallas heart study

Cardiac remodeling following reperfused acute myocardial infarction is linked to the concomitant evolution of vascular function as assessed by cardiovascular magnetic resonance

Features of Cardiac Remodeling, Associated With Blood Pressure and Fibrosis Biomarkers, Are Frequent in Subjects With Abdominal Obesity

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