Fabian aus dem Siepen1, Sebastian J Buss2, Daniel Messroghli3, Florian Andre1, Dirk Lossnitzer1, Sebastian Seitz1, Marius Keller1, Philipp A Schnabel4, Evangelos Giannitsis1, Grigorios Korosoglou1, Hugo A Katus1, Henning Steen1. 1. Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany. 2. Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany sebastian.buss@med.uni-heidelberg.de. 3. Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, Berlin 13353, Germany. 4. Institute for Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, Heidelberg 69120, Germany.
Abstract
AIM: The aim of this study was to determine the value of extracellular volume fraction (ECV) for the non-invasive assessment of diffuse myocardial fibrosis (MF) in different stages of systolic left ventricular (LV) dysfunction in dilated cardiomyopathy (DCM) in comparison with endomyocardial biopsy. BACKGROUND: Non-invasive ECV assessment using cardiovascular magnetic resonance (CMR) T1 mapping reflects diffuse MF in patients with severe DCM, but earlier stages of DCM with mild LV functional impairment have not been investigated yet. METHODS: Forty-five subjects with mild functional impairment and LV dilation ['early DCM', ejection fraction (EF) 45-55%], 29 with LV dysfunction and volume dilatation ('DCM', EF <45%) and 56 healthy volunteers (controls) underwent standard CMR imaging, late gadolinium enhancement (LGE) and T1 mapping for the calculation of ECV. The collagen volume fraction (CVF) was quantified histologically from endomyocardial biopsies of 24 DCM patients out of the study cohort. RESULTS: The ECV between 'early DCM' (25 ± 4%), 'DCM' (27 ± 4%), and controls (23 ± 3; P < 0.05 for all) differed significantly. There was a weak inverse correlation between ECV and EF (r = -0.35; P < 0.01). A strong correlation between ECV and CVF could be detected (r = 0.85; P = 0.01). The cut-off value for ECV to differentiate between healthy myocardium and DCM was 26% (specificity 91.1%, sensitivity 62.1%, area under the curve 0.8, P < 0.0001). ECV is already elevated at early stages of functional impairment, whereby an overlap between early DCM and controls is present. But 31% of the early DCM patients had an ECV fraction above the mean ±2 SD ECV of controls. CONCLUSIONS: ECV measurement with CMR reflects myocardial collagen content in DCM. Therefore, CMR-based assessment of ECV may have the potential to serve as a non-invasive tool for the quantification of diffuse MF in order to monitor therapy response and aid risk stratification in different stages of DCM. Published on behalf of the European Society of Cardiology. All rights reserved.
AIM: The aim of this study was to determine the value of extracellular volume fraction (ECV) for the non-invasive assessment of diffuse myocardial fibrosis (MF) in different stages of systolic left ventricular (LV) dysfunction in dilated cardiomyopathy (DCM) in comparison with endomyocardial biopsy. BACKGROUND: Non-invasive ECV assessment using cardiovascular magnetic resonance (CMR) T1 mapping reflects diffuse MF in patients with severe DCM, but earlier stages of DCM with mild LV functional impairment have not been investigated yet. METHODS: Forty-five subjects with mild functional impairment and LV dilation ['early DCM', ejection fraction (EF) 45-55%], 29 with LV dysfunction and volume dilatation ('DCM', EF <45%) and 56 healthy volunteers (controls) underwent standard CMR imaging, late gadolinium enhancement (LGE) and T1 mapping for the calculation of ECV. The collagen volume fraction (CVF) was quantified histologically from endomyocardial biopsies of 24 DCMpatients out of the study cohort. RESULTS: The ECV between 'early DCM' (25 ± 4%), 'DCM' (27 ± 4%), and controls (23 ± 3; P < 0.05 for all) differed significantly. There was a weak inverse correlation between ECV and EF (r = -0.35; P < 0.01). A strong correlation between ECV and CVF could be detected (r = 0.85; P = 0.01). The cut-off value for ECV to differentiate between healthy myocardium and DCM was 26% (specificity 91.1%, sensitivity 62.1%, area under the curve 0.8, P < 0.0001). ECV is already elevated at early stages of functional impairment, whereby an overlap between early DCM and controls is present. But 31% of the early DCMpatients had an ECV fraction above the mean ±2 SD ECV of controls. CONCLUSIONS: ECV measurement with CMR reflects myocardial collagen content in DCM. Therefore, CMR-based assessment of ECV may have the potential to serve as a non-invasive tool for the quantification of diffuse MF in order to monitor therapy response and aid risk stratification in different stages of DCM. Published on behalf of the European Society of Cardiology. All rights reserved.
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: Jong-Chan Youn; Yoo Jin Hong; Hye-Jeong Lee; Kyunghwa Han; Chi Young Shim; Geu-Ru Hong; Young Joo Suh; Jin Hur; Young Jin Kim; Byoung Wook Choi; Seok-Min Kang Journal: Eur Radiol Date: 2017-04-24 Impact factor: 5.315