Author + information
- Received October 18, 2016
- Revision received January 4, 2017
- Accepted January 19, 2017
- Published online January 1, 2018.
- Julia Anna Lurz, MDa,
- Christian Luecke, MDb,
- David Lang, BScc,
- Christian Besler, MDc,
- Karl-Philipp Rommel, MDc,
- Karin Klingel, MDd,
- Reinhard Kandolf, MDd,
- Volker Adams, PhDc,
- Katharina Schöne, MDa,
- Gerhard Hindricks, MDa,
- Gerhard Schuler, MDc,
- Axel Linke, MDc,
- Holger Thiele, MDe,
- Matthias Gutberlet, MDb and
- Philipp Lurz, MD, PhDc,∗ ()
- aDepartment of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
- bDepartment of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany
- cDepartment of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
- dDepartment of Molecular Pathology, University Hospital Tuebingen, Tuebingen, Germany
- eUniversity Heart Center Luebeck, University of Schleswig-Holstein, Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), Luebeck, Germany
- ↵∗Address for correspondence:
Dr. Philipp Lurz, Department of Internal Medicine/Cardiology, Heart Center, Leipzig University, Struempellstrasse 39, 4289 Leipzig, Germany.
Objectives The aim of the present study was to evaluate whether extracellular volume fraction (ECV) can reliably inform on the extent of diffuse fibrosis in the simultaneous presence of myocardial inflammation, which has not been verified to date.
Background Diffuse myocardial fibrosis is associated with unfavorable outcome in patients with cardiomyopathy, and is of prognostic relevance. Assessment of ECV bears promise for being a noninvasive surrogate parameter, but it may be altered by other pathologies.
Methods In this prospective study, 107 consecutive patients with clinical suspicion of inflammatory cardiomyopathy were included. All patients underwent left ventricular (LV) endomyocardial biopsy (EMB) and cardiac magnetic resonance imaging on a 1.5-T scanner. T1 mapping was obtained with the modified Look-Locker inversion recovery sequence, and ECV was calculated.
Results Myocardial inflammation was present in 66 patients. Patients with and without inflammation were of similar age and had comparable LV ejection fraction (37 ± 17% vs. 36 ± 18%; p = 0.9) and symptom duration (median 14 days [interquartile range: 5 to 36 days] vs. median 14 days [interquartile range: 7 to 30 days]; p = 0.73). Although LV collagen volume percentage was comparable between groups (inflammation 12.3 ± 17.8% vs. noninflammation 11.4 ± 7.9%; p = 0.577), ECV was significantly higher in patients with inflammation (0.37 ± 0.06%) than in those without inflammation (0.33 ± 0.08%; p = 0.02). Importantly, ECV adequately estimated the degree of LV fibrosis percentage only in patients without inflammation (r = 0.72; p < 0.0001) and not in those with inflammation (r = 0.24; p = 0.06).
Conclusions These findings prove the theoretical concept of ECV as an estimate for diffuse myocardial fibrosis, but only in the absence of significant myocardial inflammation. Assuming that various degrees of myocardial inflammation and fibrosis coexist in such a scenario, the measured ECV will reflect a sum of these different pathologies but will not inform solely on the extent of diffuse fibrosis.
This work was supported by the Deutsche Forschungsgemeinschaft (SFB TR19) and the Federal Ministry of Education and Research (01EZ0817) via grants to Drs. Klingel and Kandolf. Dr. Hindricks has received grants through the University of Leipzig-Heart Center from St. Jude Medical and Boston Scientific. Dr. Linke has received grant support from Claret Medical, Inc. and Medtronic; has received speaker honoraria from or served as a consultant for Medtronic, St. Jude Medical, Abbott, Boston Scientific, Edwards Lifesciences, Symetis, and Bard; and holds stock options in Claret Medical, Inc. Dr. Gutberlet has received honoraria from Siemens, Philips, Bayer, and Bracco. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 18, 2016.
- Revision received January 4, 2017.
- Accepted January 19, 2017.
- 2018 American College of Cardiology Foundation