Andris H Ellims1, James A Shaw1, Dion Stub1, Leah M Iles1, James L Hare1, Glenn S Slavin2, David M Kaye1, Andrew J Taylor3. 1. Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia. 2. GE Healthcare, Bethesda, Maryland. 3. Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia. Electronic address: andrew.taylor@bakeridi.edu.au.
Abstract
OBJECTIVES: The purpose of this study was to use cardiac magnetic resonance (CMR) imaging and invasive left ventricular (LV) pressure-volume (PV) measurements to explore the relationship between diffuse myocardial fibrosis and indexes of diastolic performance in a cohort of cardiac transplant recipients. BACKGROUND: The precise mechanism of LV diastolic dysfunction in the presence of myocardial fibrosis has not previously been established. METHODS: We performed CMR with T1 mapping and obtained invasive LV PV measurements via a conductance catheter in 20 cardiac transplant recipients at the time of clinically-indicated coronary angiography. RESULTS: Both post-contrast myocardial T1 time and extracellular volume fraction correlated with β, the load-independent passive LV stiffness constant (r = -0.71, p = 0.001, and r = 0.58, p = 0.04, respectively). After multivariate analysis, post-contrast myocardial T1 time remained the only independent predictor of β. No significant associations were observed between myocardial T1 time and τ, the active LV relaxation constant, or other load-dependent parameters of diastolic function. CONCLUSIONS: Diffuse myocardial fibrosis, assessed by post-contrast myocardial T1 time, correlates with invasively-demonstrated LV stiffness in cardiac transplant recipients. In patients with increased diffuse myocardial fibrosis, abnormal passive ventricular stiffness is therefore likely to be a major contributor to diastolic dysfunction.
OBJECTIVES: The purpose of this study was to use cardiac magnetic resonance (CMR) imaging and invasive left ventricular (LV) pressure-volume (PV) measurements to explore the relationship between diffuse myocardial fibrosis and indexes of diastolic performance in a cohort of cardiac transplant recipients. BACKGROUND: The precise mechanism of LV diastolic dysfunction in the presence of myocardial fibrosis has not previously been established. METHODS: We performed CMR with T1 mapping and obtained invasive LV PV measurements via a conductance catheter in 20 cardiac transplant recipients at the time of clinically-indicated coronary angiography. RESULTS: Both post-contrast myocardial T1 time and extracellular volume fraction correlated with β, the load-independent passive LV stiffness constant (r = -0.71, p = 0.001, and r = 0.58, p = 0.04, respectively). After multivariate analysis, post-contrast myocardial T1 time remained the only independent predictor of β. No significant associations were observed between myocardial T1 time and τ, the active LV relaxation constant, or other load-dependent parameters of diastolic function. CONCLUSIONS: Diffuse myocardial fibrosis, assessed by post-contrast myocardial T1 time, correlates with invasively-demonstrated LV stiffness in cardiac transplant recipients. In patients with increased diffuse myocardial fibrosis, abnormal passive ventricular stiffness is therefore likely to be a major contributor to diastolic dysfunction.
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