Nicola C Edwards1, William E Moody2, Mengshi Yuan2, Peter Weale2, Desley Neal2, Jonathan N Townend2, Richard P Steeds2. 1. From the Department of Cardiovascular Medicine, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom (N.C.E., W.E.M., J.N.T., R.P.S.); Departments of Cardiology (N.C.E., W.E.M., M.Y., J.N.T.) and Pathology (D.N.), University of Birmingham and Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; and Imaging and Therapy Systems Department, Siemens Healthcare, Surrey, United Kingdom (P.W.). n.c.edwards@bham.ac.uk. 2. From the Department of Cardiovascular Medicine, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom (N.C.E., W.E.M., J.N.T., R.P.S.); Departments of Cardiology (N.C.E., W.E.M., M.Y., J.N.T.) and Pathology (D.N.), University of Birmingham and Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; and Imaging and Therapy Systems Department, Siemens Healthcare, Surrey, United Kingdom (P.W.).
Abstract
BACKGROUND: The optimum timing of surgery in asymptomatic patients with chronic severe primary degenerative mitral regurgitation (MR) remains controversial, and further markers are needed to improve decision-making. There are limited data that wall stress is increased in MR and may result in ventricular fibrosis. We investigated the hypothesis that chronic volume overload in MR is a stimulus for myocardial fibrosis using T1-mapping cardiac MRI. METHODS AND RESULTS: A cross-sectional study of 35 patients (age 60 ± 14 years) with asymptomatic moderate and severe primary degenerative MR (mean effective regurgitant orifice area, 0.45 ± 0.25 cm)(2) with no class I indication for surgery were compared with age and sex controls. Subjects were studied with cardiopulmonary exercise testing, echocardiography, and cardiac MRI. Longitudinal and circumferential myocardial deformation was reduced with MR when left ventricular ejection fraction (67% ± 10%) and N-terminal pro B Natriuretic peptide (126 [76-428] ng/L) were within the normal range. Myocardial extracellular volume was increased (0.32 ± 0.07 versus 0.25 ± 0.02, P<0.01) and was associated with increased left ventricular end-systolic volume index (r=0.62, P<0.01), left atrial volume index (r=0.41, P<0.05) but lower left ventricular ejection fraction (r=-0.60, P<0.01), longitudinal function (mitral annular plane systolic excursion, r=-0.46, P<0.01), and peak VO2 max (r=-0.51, P<0.05). In a multivariable regression model, left ventricular end-systolic volume index and left atrial volume index were independent predictors of extracellular volume (r(2)=0.42, P<0.01). CONCLUSIONS: Patients with asymptomatic MR demonstrate a spectrum of myocardial fibrosis associated with reduced myocardial deformation and reduced exercise capacity. Future work is warranted to investigate whether left ventricle fibrosis affects clinical outcomes.
BACKGROUND: The optimum timing of surgery in asymptomatic patients with chronic severe primary degenerative mitral regurgitation (MR) remains controversial, and further markers are needed to improve decision-making. There are limited data that wall stress is increased in MR and may result in ventricular fibrosis. We investigated the hypothesis that chronic volume overload in MR is a stimulus for myocardial fibrosis using T1-mapping cardiac MRI. METHODS AND RESULTS: A cross-sectional study of 35 patients (age 60 ± 14 years) with asymptomatic moderate and severe primary degenerative MR (mean effective regurgitant orifice area, 0.45 ± 0.25 cm)(2) with no class I indication for surgery were compared with age and sex controls. Subjects were studied with cardiopulmonary exercise testing, echocardiography, and cardiac MRI. Longitudinal and circumferential myocardial deformation was reduced with MR when left ventricular ejection fraction (67% ± 10%) and N-terminal pro B Natriuretic peptide (126 [76-428] ng/L) were within the normal range. Myocardial extracellular volume was increased (0.32 ± 0.07 versus 0.25 ± 0.02, P<0.01) and was associated with increased left ventricular end-systolic volume index (r=0.62, P<0.01), left atrial volume index (r=0.41, P<0.05) but lower left ventricular ejection fraction (r=-0.60, P<0.01), longitudinal function (mitral annular plane systolic excursion, r=-0.46, P<0.01), and peak VO2 max (r=-0.51, P<0.05). In a multivariable regression model, left ventricular end-systolic volume index and left atrial volume index were independent predictors of extracellular volume (r(2)=0.42, P<0.01). CONCLUSIONS:Patients with asymptomatic MR demonstrate a spectrum of myocardial fibrosis associated with reduced myocardial deformation and reduced exercise capacity. Future work is warranted to investigate whether left ventricle fibrosis affects clinical outcomes.
Authors: Francesco Sardanelli; Simone Schiaffino; Moreno Zanardo; Francesco Secchi; Paola Maria Cannaò; Federico Ambrogi; Giovanni Di Leo Journal: Eur Radiol Date: 2019-05-02 Impact factor: 5.315
Authors: Danai Kitkungvan; Eric Y Yang; Kinan C El Tallawi; Sherif F Nagueh; Faisal Nabi; Mohammad A Khan; Duc T Nguyen; Edward A Graviss; Gerald M Lawrie; William A Zoghbi; Robert O Bonow; Miguel A Quinones; Dipan J Shah Journal: Circulation Date: 2019-12-16 Impact factor: 29.690
Authors: Simon Ermakov; Radhika Gulhar; Lisa Lim; Dwight Bibby; Qizhi Fang; Gregory Nah; Theodore P Abraham; Nelson B Schiller; Francesca N Delling Journal: Heart Date: 2019-02-12 Impact factor: 5.994