In vivo quantitative ultrasonic evaluation of myocardial fibrosis in humans.

Picaño, Eugenio; Pelosi, G; Marzilli, Mario; Lattanzi, Fabio; Benassi, A.; Landini, Luigi; LʼAbbate, Antonio

doi:10.1161/01.cir.81.1.58

Cited by 214 publications

(143 citation statements)

References 18 publications

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“…In experimental studies, IBS absolute values have been shown to be reliable indices of LV fibrosis. In addition, they have been shown to reflect myocardial collagen content as assessed by endomyocardial biopsy in humans (15,16,18). It has been demonstrated that even mild reductions in renal function are associated with a greater prevalence of LVH (27,28); the increase in IBS reflectivity that was observed in our study also indicates an early increase in LV collagen deposition, beginning well before the development of ESRD.…”

Section: Discussionsupporting

confidence: 63%

“…Experimental studies have suggested that integrated backscatter (IBS) measures may be related to myocardial collagen content (11)(12)(13)(14). In humans, ultrasonic backscatter indices have been shown to be related to myocardial collagen content as assessed by endomyocardial biopsy (15)(16)(17)(18). Therefore, we considered it worthwhile to analyze myocardial ultrasonic backscatter (IBS) in patients who had CRF and were undergoing hemodialysis, in patients with mild to moderate CRF, and in patients with essential hypertension with comparable age, BP values and LVM to evaluate whether interstitial collagen deposition as evaluated by acoustic densitometry may appear early in the course of chronic kidney disease (CKD).…”

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confidence: 99%

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Myocardial Ultrasound Tissue Characterization in Patients with Chronic Renal Failure

Salvetti¹,

Muiesan²,

Paini³

et al. 2007

Journal of the American Society of Nephrology

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The objective of this study was to detect ultrastructural changes in myocardium related to collagen content by ultrasound tissue characterization in patients with chronic kidney disease (CKD) and in uncomplicated hypertensive control subjects. In 25 hemodialysis (HD) patients, in 25 patients with moderate to severe chronic renal failure (CRF), and in 10 patients with essential hypertension (EH) and normal renal function matched for age, BP, and left ventricular mass index, left ventricular anatomy and function were evaluated by conventional echocardiography, and integrated backscatter signal (IBS) was analyzed by acoustic densitometry. IBS mean reflectivity increased from 48% in patients with EH to 56% in patients with CRF to 62% in HD patients (ANOVA P < 0.01). IBS mean cyclic variation was progressively increased from 4.35 ؎ 1.2 dB in HD patients to 5.27 ؎ 0.90 in patients with CRF to 6.50 ؎ 1.6 dB in patients with EH (ANOVA P < 0.01). At multivariate analysis, IBS mean reflectivity was positively related to age and serum creatinine (␤ 0.351, P ‫؍‬ 0.036; and ␤ ‫؍‬ 0.408, P ‫؍‬ 0.016, respectively). IBS mean cyclic variation was inversely related to age and serum creatinine (␤ ‫؍‬ ؊0.274, P ‫؍‬ 0.025; and ␤ ‫؍‬ ؊0.262, P ‫؍‬ 0.025, respectively) and positively related to left ventricular midwall fractional shortening and transmitral E/A ratio (␤ ‫؍‬ 0.269, P < 0.05; and ␤ ‫؍‬ 0.314, P < 0.001, respectively). The data support the hypothesis that interstitial collagen deposition may appear early in the course of CKD and suggest that acoustic densitometry may represent a useful tool for the assessment of myocardial tissue changes in patients with CKD. 18: 195318: -195818: , 200718: . doi: 10.1681 L eft ventricular hypertrophy (LVH) is an independent predictor of cardiovascular morbidity and mortality in patients with ESRD as well as in hypertensive patients, in patients with coronary artery disease, and in the general population (1). It has been demonstrated that changes in LV mass index (LVMI) over time are associated with cardiovascular prognosis (2-4), and LVH is currently considered an important intermediate end point in the treatment of hypertensive patients (5,6). A greater prevalence of LVH has been reported in patients with chronic renal failure (CRF) (7), possibly contributing to the greater risk for cardiovascular events in these patients (8,9). Experimental studies have demonstrated that the typical changes in uremic cardiomyopathy are increased cardiac size, interstitial and perivascular fibrosis, reduced capillary density, and thickening of intramural myocardial arterioles (10). J Am Soc NephrolAcoustic densitometry is a noninvasive tool for the evaluation of myocardial tissue characteristics and provides an integrated on-line capability to measure, display, and analyze the average acoustic image intensity within a user-specified region of interest (ROI). Experimental studies have suggested that integrated backscatter (IBS) measures may be related to myocardial collagen content (11)(12)(13)(14). I...

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Section: Discussionsupporting

confidence: 63%

mentioning

confidence: 99%

Myocardial Ultrasound Tissue Characterization in Patients with Chronic Renal Failure

Salvetti¹,

Muiesan²,

Paini³

et al. 2007

Journal of the American Society of Nephrology

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“…The extracellular matrix represents an important source of myocardial IBS, 14 and several experimental studies have demonstrated that IBS in diastole correlates with the collagen content within the myocardium. 15,16 Therefore, the acoustic densitometry technique can noninvasively provide a relative estimate of myocardial fibrosis. The standardized IBS and cyclic variation of IBS data were significantly improved in SHRs treated with rosiglitazone when compared with SHRs treated with saline.…”

Section: Discussionmentioning

confidence: 99%

Rosiglitazone attenuates myocardial remodeling in spontaneously hypertensive rats

Hao

et al. 2011

Hypertens Res

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Rosiglitazone, an important peroxisome proliferator-activated receptor-c (PPAR-c) agonist, improves left ventricular (LV) hypertrophy in diet-induced hypercholesterolemic rats. However, the effects and underlying mechanisms of rosiglitazone on myocardial remodeling in spontaneous hypertension rats (SHRs) are unclear. Twenty male 8-week-old SHRs were randomly divided into two groups: one treated with oral saline (n¼10) and the other treated with rosiglitazone (5 mg kg À1 day À1 , n¼10). Ten age-matched Wistar-Kyoto rats were selected as a normal control group. Echocardiography, immunohistochemistry, real-time reverse transcriptase-PCR and western blot analysis were performed to assess the effects of rosiglitazone. After 16 weeks of treatment, LV hypertrophy was significantly attenuated by rosiglitazone (LV weight/body weight, 2.35±0.11 vs. 2.56 ± 0.14 mg g À1 ). According to the echocardiography results, thickening of the LV wall was reduced, and mid-wall fractional shortening was improved by rosiglitazone. Similarly, the excessive collagen deposition and upregulation of collagen I and collagen III seen in SHRs receiving saline were significantly attenuated in SHRs receiving rosiglitazone. In addition, rosiglitazone treatment increased the activity of matrix metalloproteinase-9 (MMP-9) and normalized the MMP-9/tissue inhibitor of metalloproteinase-1 ratio. Furthermore, activator protein-1 (AP-1) activation and nuclear factor-kappa B (NF-jB) expression were suppressed in the rosiglitazone-treated group. These results demonstrate that the PPAR-c agonist rosiglitazone had beneficial effects on myocardial remodeling in SHRs by way of decreasing AP-1 activation and NF-jB expression, which may help in further inhibiting transcription of the downstream genes involved in the pathogenesis of myocardial remodeling induced by hypertension.

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“…Heart tissue characterization by means of echocardiography via the integrated backscatter (IBS) technique was also performed in a subset of cirrhotic patients in an attempt to obtain information on myocardial texture to assess whether hypertrophy or fibrosis is the background morphological change. This technique allows to obtain an indirect estimate of tissue density, usually decreased when a higher percentage of muscle fibres is present and increased when fibrosis prevails [36,37]. We also obtained information on the effects of aging on the morphofunctional heart changes observed.…”

Section: Introductionmentioning

confidence: 99%

Heart Function and Myocardial Tissue Characterization in Patients with HCV Related Cirrhosis: Diastolic Dysfunction and Cardiac Hypertrophy

Pozzi¹,

Pizzala²,

Ratti³

et al. 2007

TOGASJ

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Evidence of diastolic dysfunction in cirrhosis contributed to the definition of cirrhotic cardiomyopathy. In 109 patients with chronic HCV infection with or without cirrhosis E/A ratio, a Doppler marker of diastolic dysfunction, was decreased in cirrhotics (0.89 ± 0.03 vs controls 1.21 ± 0.07, p < 0.01) and to a lesser extent in patients with advanced liver fibrosis (1.17 ± 0.07, p < 0.01). Left ventricular parietal wall thickness was increased. The nature of this abnormality in human cirrhosis has not been clarified, animal studies reporting cardiac hypertrophy. To this aim we employed the echocardiographic integrated backscatter (IBS) technique to obtain an indirect estimate of tissue density (decreased when a higher percentage of muscle fibres is present and increased when fibrosis prevails) to provide myocardial tissue characterization in a subset of patients with compensated HCV cirrhosis. The average IBS signal was reduced in cirrhotics at the level of the posterior wall (21.72 ± 1.46 dB versus 30.85 ± 1.40 dB in controls, p < 0.01). Our results confirm diastolic dysfunction in postviral cirrhosis pointing to cardiac hypertrophy as the anatomopathological background in the compensated stage of disease.

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In vivo quantitative ultrasonic evaluation of myocardial fibrosis in humans.

Cited by 214 publications

References 18 publications

Myocardial Ultrasound Tissue Characterization in Patients with Chronic Renal Failure

Myocardial Ultrasound Tissue Characterization in Patients with Chronic Renal Failure

Rosiglitazone attenuates myocardial remodeling in spontaneously hypertensive rats

Heart Function and Myocardial Tissue Characterization in Patients with HCV Related Cirrhosis: Diastolic Dysfunction and Cardiac Hypertrophy

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