Synopsis

Keywords: Myocardium, Quantitative Imaging

HFpEF was seen approximately in half of all hospitalized patients for heart failure and is associated with a poor prognosis. Using CMR, the present study shows that the increased diffuse myocardial fibrosis was associated with the degree of impaired myocardial strain in patients with HFpEF. As diffuse fibrosis is recognized as prognostic markers and reversible. Our findings demonstrate the utility of myocardial strain in assessing patients with HFpEF. The measurement of myocardial strain could be used to inform clinicians about whether HF medications could improve the degree of diffuse myocardial fibrosis in HFpEF.

Objectives

The purpose of this study was to investigate the extent of the left ventricular (LV) diffuse myocardial fibrosis and the association with the degree of impaired myocardial strain in patients with HFpEF.

Background

The increased diffuse myocardial fibrosis impairs the LV systolic and diastolic function. Previous studies found that the global longitudinal strain (GLS) impacted survival in patients with heart failure with preserved ejection fraction (HFpEF). However, limited data are available regarding the association between the degree of diffuse myocardial fibrosis and the severity of impaired myocardial strain in HFpEF.

Methods

Sixty-six consecutive participants with heart failure (HF), and 15 healthy controls underwent cardiac magnetic resonance (CMR) examination (Ingenia 3.0T, Philips Healthcare, Best, the Netherlands). The extracellular volume fractions (ECV) and myocardial strains were compared among the 3 groups. Associations between these two factors were also explored.

Results

The patients with HFpEF showed increased myocardial ECV fractions (32.9%±3.7% vs. 29.2%±2.9%, p<0.001) compared with the control group. The patients with HFm+rEF also had increased myocardial ECV fractions (36.8%±5.4% vs. 32.9%±3.7%, p<0.001) compared with HFpEF. The myocardial ECV was significantly correlated with the GLS (r=0.422, p=0.020), global circumferential strain (GCS) (r=0.491, p=0.006), and global radial strain (GRS) (r=-0.533, p=0.002) in the HFpEF groups, but no significant correlation was found in the HFm+rEF group (GLS: r=-0.002, p=0.990; GCS: r=0.153, p=0.372; GRS: r=0.070, p=0.685) .

Conclusions

In HF patients, only patients with HFpEF exhibited a significant correlation between increased diffuse myocardial fibrosis and impaired myocardial strain. Diffuse myocardial fibrosis plays a unique role in affecting myocardial strain in patients with HFpEF.

Acknowledgements

No acknowledgement found.

References

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