Author + information
- Received February 3, 2014
- Revision received April 9, 2014
- Accepted April 22, 2014
- Published online October 1, 2014.
- Mao-Yuan M. Su, PhD∗,
- Lian-Yu Lin, MD, PhD†,
- Yao-Hui E. Tseng, MD∗,
- Chin-Chen Chang, MD∗,
- Cho-Kai Wu, MD†,
- Jiunn-Lee Lin, MD, PhD†∗∗ ( and )
- Wen-Yih I. Tseng, MD, PhD∗,‡∗ ()
- ∗Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
- †Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- ‡Center for Optoelectronic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- ↵∗Reprint requests and correspondence:
Dr. Wen-Yih I. Tseng, Center for Optoelectronic Medicine, National Taiwan University College of Medicine, No. 1, Jen-Ai Road, Section 1, Taipei, Taiwan.
- ↵∗∗Dr. Jiunn-Lee Lin, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chun-Shan S. Road, Taipei, Taiwan.
Objectives The purpose of this study was to investigate diffuse myocardial fibrosis in patients with systolic heart failure (SHF) and in patients with heart failure with preserved ejection fraction (HFpEF) and the association with diastolic dysfunction of the left ventricle (LV).
Background Increased diffuse myocardial fibrosis may impair LV diastolic function. However, no study has verified the association between the degree of diffuse myocardial fibrosis and the severity of impaired diastolic function in SHF and HFpEF.
Methods Forty patients with SHF, 62 patients with HFpEF, and 22 patients without HF underwent cardiac magnetic resonance (CMR), including T1 mapping and cine CMR on a 3-T system. Extracellular volume fraction (ECV), a measure of diffuse myocardial fibrosis, was quantified from T1 mapping. Systolic and diastolic functions of the LV were assessed by cine CMR. The ECV values and LV functional indexes were compared among the 3 groups. Associations between ECV and LV diastolic function were also investigated.
Results Compared with patients without HF, significantly higher ECV was found in patients with SHF (31.2% [interquartile range (IQR): 29.0% to 34.1%] vs. 27.9% [IQR: 26.2% to 29.4%], p < 0.001) and HFpEF (28.9% [IQR: 27.8% to 31.3%] vs. 27.9% [IQR: 26.2% to 29.4%], p = 0.006). Peak filling rate, a diastolic functional index assessed by cine CMR, was significantly decreased in patients with SHF (1.00 s−1 [IQR: 0.79 to 1.49 s−1] vs. 3.86 s−1 [IQR: 3.34 to 4.48 s−1], p < 0.001) and HFpEF (2.89 s−1 [IQR: 2.13 to 3.50 s−1] vs. 3.86 s−1 [IQR: 3.34 to 4.48 s−1], p < 0.001). Myocardial ECV was significantly correlated with peak filling rate in the HFpEF group (r = −0.385, p = 0.002), but no correlation was found in the SHF and non-HF groups (r = 0.030, p = 0.856 and r = −0.238, p = 0.285, respectively).
Conclusions In patients with HF, only those with HFpEF show a significant correlation between increased diffuse myocardial fibrosis and impaired diastolic function. Diffuse myocardial fibrosis plays a unique role in the pathogenesis of HFpEF.
- cardiac magnetic resonance
- extracellular volume fraction
- heart failure with preserved ejection fraction
This work was supported in part by the National Science Council, Taiwan (grants NSC-102-2314-B-002-087-MY2 and NSC102-2314-B-002-071-MY3). All authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Su and Lin contributed equally to this work.
- Received February 3, 2014.
- Revision received April 9, 2014.
- Accepted April 22, 2014.
- American College of Cardiology Foundation