Progression of Myocardial Fibrosis Assessed With Cardiac Magnetic Resonance in Hypertrophic Cardiomyopathy

Todiere, Giancarlo; Aquaro, Giovanni Donato; Piaggi, Paolo; Formisano, Francesco; Barison, Andrea; Masci, Pier Giorgio; Strata, Elisabetta; Bacigalupo, Lorenzo; Marzilli, Mario; Pingitore, Alessandro; Lombardi, Massimo

doi:10.1016/j.jacc.2012.03.076

Cited by 134 publications

(108 citation statements)

References 31 publications

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“…Notably, 5 patients showed LGE expansion, and among these none experienced LV-RR and 4 had a decrease in LV ejection fraction ≥10 U during follow-up. Although an increase in LGE extent over time has been recently reported in hypertrophic cardiomyopathy, 28 to the best of our knowledge, this is the first study that indicates that LGE is not fixed but is rather a dynamic process in IDCM, and its increase is associated with progressive LV dysfunction. Cumulating evidence suggests that replacement MF, as detected by LGE technique, occurs as a result of progressive myocyte loss via necrotic, apoptotic, or autophagic cell pathway and alteration of extracellular matrix constituents, 29 which are, in turn, influenced by genetic predisposition, myocardial ischemia, increased wall stress, and activation of renin-angiotensinaldosterone system.…”

Section: Discussionmentioning

confidence: 56%

Myocardial Fibrosis as a Key Determinant of Left Ventricular Remodeling in Idiopathic Dilated Cardiomyopathy

Masci

Schuurman

Barison

et al. 2013

Circ: Cardiovascular Imaging

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142

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Background-In idiopathic dilated cardiomyopathy, there are scarce data on the influence of late gadolinium enhancement (LGE) assessed by cardiovascular magnetic resonance on left ventricular (LV) remodeling. Methods and Results-Fifty-eight consecutive patients with idiopathic dilated cardiomyopathy underwent baseline clinical, biohumoral, and instrumental workup. Medical therapy was optimized after study enrollment. Cardiovascular magnetic resonance was used to assess ventricular volumes, function, and LGE extent at baseline and 24-month follow-up. LV reverse remodeling (RR) was defined as an increase in LV ejection fraction ≥10 U, combined with a decrease in LV end-diastolic volume ≥10% at follow-up. ΔLGE extent was the difference in LGE extent between follow-up and baseline. LV-RR was observed in 22 patients (38%). Multivariate regression analysis showed that the absence of LGE at baseline cardiovascular magnetic resonance was a strong predictor of LV-RR (odds ratio, 10.857 [95% confidence interval, 1.844-63.911]; P=0.008) after correction for age, heart rate, New York Heart Association class, LV volumes, and LV and right ventricular ejection fractions. All patients with baseline LGE (n=26; 45%) demonstrated LGE at follow-up, and no patient without baseline LGE developed LGE at follow-up. In LGE-positive patients, there was an increase in LGE extent over time (P=0.034), which was inversely related to LV ejection fraction variation (Spearman ρ, −0.440; P=0.041). Five patients showed an increase in LGE extent >75th percentile of ΔLGE extent, and among these none experienced LV-RR and 4 had a decrease in LV ejection fraction ≥10 U at follow-up. Conclusions-In patients with idiopathic dilated cardiomyopathy, the absence of LGE at baseline is 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. The increase in LGE extent during follow-up was associated with progressive LV dysfunction. (Circ Cardiovasc Imaging. 2013;6:790-799.)

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Section: Discussionmentioning

confidence: 56%

Myocardial Fibrosis as a Key Determinant of Left Ventricular Remodeling in Idiopathic Dilated Cardiomyopathy

Masci

Schuurman

Barison

et al. 2013

Circ: Cardiovascular Imaging

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142

110

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“…In a recent study by Todiere et al (99), increases in myocardial LGE were shown in HCM patients during a mean follow-up period of nearly 2 years (Fig 12), predicting worsening clinical status. However, such widespread rapid increase in myocardial fibrosis is likely exaggerated by patient selection bias.…”

Section: Role Of Mr Imaging In Assessing Microvascular Dysfunction Anmentioning

confidence: 87%

MR Imaging in Hypertrophic Cardiomyopathy: From Magnet to Bedside

Bogaert¹,

Olivotto²

2014

Radiology

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“…Myocardial fibrosis, which plays a key role in HCM pathophysiology, could contribute to atrial fibrillation, ventricular tachycardia, LV dysfunction and SCD [24,25,26,27,28,29]. CMR allowed the noninvasive detection and quantification of myocardial fibrosis by LGE.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Long-Term Outcome between Apical and Asymmetric Septal Hypertrophic Cardiomyopathy

Fan²,

Lu³

et al. 2016

Cardiology

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Objectives: As reported, diagnostic age, gender and presence of outflow tract obstruction have an impact on prognosis in patients with hypertrophic cardiomyopathy. The aim of this study was to compare the long-term outcome between apical hypertrophic cardiomyopathy (ApHCM) and asymmetric septal hypertrophic cardiomyopathy (ASHCM) after the exclusion of these factors. Methods: A total of 540 patients (270 with ApHCM and 270 with ASHCM) identified in a consecutive single-center cohort were retrospectively studied. The two groups were matched by diagnostic age, gender and the presence of outflow tract obstruction. Clinical characteristics and long-term outcomes were compared. Results: The mean follow-up duration in ASHCM and ApHCM were 6.6 ± 5.5 and 7.6 ± 4.1 years, respectively. During follow-up, 16 patients experienced cardiovascular death in the ASHCM group, while 2 patients experienced cardiovascular death in the ApHCM group (6.3 vs. 0.7%, p < 0.01). Cardiovascular morbidity in the ASHCM and ApHCM groups were 39.9 and 18.5% (p < 0.01). In the multivariate Cox regression analysis late gadolinium enhancement (LGE; HR 4.81, 95% CI 1.28-78.0, p = 0.03) and unexplained syncope (HR 9.68, 95% CI 1.9-17.2, p < 0.01) were independent predictors for cardiovascular mortality. Unexplained syncope was independently associated with a higher risk for sudden cardiac death (HR 4.3, 95% CI 1.2-15.3, p = 0.02). Conclusions: After eliminating the interference of diagnostic age, gender and outflow tract obstruction, ASHCM represented a worse prognosis with a higher incidence of cardiovascular mortality and morbidity than ApHCM. LGE was a strong predictor for cardiovascular death.

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Progression of Myocardial Fibrosis Assessed With Cardiac Magnetic Resonance in Hypertrophic Cardiomyopathy

Abstract: Myocardial fibrosis in HCM is a progressive and fast phenomenon. LGE increment, related to a worse clinical status, is more extensive in apical hypertrophy than in other patterns.

Cited by 134 publications

References 31 publications

Myocardial Fibrosis as a Key Determinant of Left Ventricular Remodeling in Idiopathic Dilated Cardiomyopathy

Myocardial Fibrosis as a Key Determinant of Left Ventricular Remodeling in Idiopathic Dilated Cardiomyopathy

MR Imaging in Hypertrophic Cardiomyopathy: From Magnet to Bedside

Comparison of Long-Term Outcome between Apical and Asymmetric Septal Hypertrophic Cardiomyopathy

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