Xiaoyu Wei1,2, Xuhua Jian3, Jiajun Xie4, Rui Chen2, Xiaodan Li2, Zhicheng Du5, Xiaomei Zhong2, Jinglei Li2, Xiaobing Zhou2, Guanmin Ren2, Yingjie Mei6, Hui Liu1,2. 1. School of Medicine, South China University of Technology, Guangzhou, China. 2. Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. 3. Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. 4. Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China. 5. Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China. 6. Philips Healthcare, Guangzhou, China.
Abstract
BACKGROUND: Left ventricular (LV) extracellular remodeling is a critical process in aortic stenosis (AS), which is related to functional abnormalities. Data regarding the use of combined T1 mapping and feature tracking (FT) to assess LV extracellular remodeling in severe AS are scarce. This study aimed to investigate the ability of T1-derived and FT-derived parameters to identify and assess the changes in process of LV extracellular remodeling in patients with severe AS. METHODS: A total of 49 patients with severe AS and 20 healthy volunteers were prospectively recruited. Modified look-locker inversion-recovery T1 mapping and FT imaging were performed in all participants using 3.0-T cardiac magnetic resonance imaging. The degree of myocardial fibrosis was quantified using Masson trichrome stain in biopsy specimens obtained intraoperatively from 13 patients and expressed as collagen volume fraction (CVF). Patients were divided into subgroups according to preserved LV ejection fraction (LVEF) (LVEF ≥50%) or reduced LVEF (LVEF <50%). RESULTS: Regarding the diffuse fibrosis burden, extracellular volume (ECV) was statistically insignificant between patients with preserved LVEF) and controls (28.0%±3.3% vs. 26.5%±2.3%, P>0.05). ECV in the reduced LVEF group (n=20) was significantly higher than that in the preserved LVEF group (n=29) (30.4%±3.9% vs. 28.0%±3.3%, P<0.05). Regarding the myocardial strain, global longitudinal strain (GLS) showed increasing impairment from the control group to the preserved LVEF AS group to the reduced LVEF AS group (-23.4%±3.3% vs. -18.6%±3.8% vs. -11.2%±4.8%, P<0.05). A significant correlation was found between ECV and CVF (r=0.64, P=0.020), whereas the correlation between GLS and CVF was insignificant. Significant correlations were observed between GLS and LV mass index (r=0.72, P=0.006) and LVEF (r=0.82, P<0.001). However, no correlations were found between ECV and LV mass index (P=0.172) and between ECV and LVEF (P=0.339). Discrimination of patients with preserved LVEF from controls, GLS yielded the best diagnostic performance as defined by the area of under the curve (-0.83), and GLS, ECV, and post-T1 were significant discriminators after regression analysis. CONCLUSIONS: In the process of LV extracellular remodeling in severe AS, ECV is the structural marker of extracellular fibrosis burden, and GLS is the functional marker before the fibrosis burden intensifies. 2020 Cardiovascular Diagnosis and Therapy. All rights reserved.
BACKGROUND: Left ventricular (LV) extracellular remodeling is a critical process in aortic stenosis (AS), which is related to functional abnormalities. Data regarding the use of combined T1 mapping and feature tracking (FT) to assess LV extracellular remodeling in severe AS are scarce. This study aimed to investigate the ability of T1-derived and FT-derived parameters to identify and assess the changes in process of LV extracellular remodeling in patients with severe AS. METHODS: A total of 49 patients with severe AS and 20 healthy volunteers were prospectively recruited. Modified look-locker inversion-recovery T1 mapping and FT imaging were performed in all participants using 3.0-T cardiac magnetic resonance imaging. The degree of myocardial fibrosis was quantified using Masson trichrome stain in biopsy specimens obtained intraoperatively from 13 patients and expressed as collagen volume fraction (CVF). Patients were divided into subgroups according to preserved LV ejection fraction (LVEF) (LVEF ≥50%) or reduced LVEF (LVEF <50%). RESULTS: Regarding the diffuse fibrosis burden, extracellular volume (ECV) was statistically insignificant between patients with preserved LVEF) and controls (28.0%±3.3% vs. 26.5%±2.3%, P>0.05). ECV in the reduced LVEF group (n=20) was significantly higher than that in the preserved LVEF group (n=29) (30.4%±3.9% vs. 28.0%±3.3%, P<0.05). Regarding the myocardial strain, global longitudinal strain (GLS) showed increasing impairment from the control group to the preserved LVEF AS group to the reduced LVEF AS group (-23.4%±3.3% vs. -18.6%±3.8% vs. -11.2%±4.8%, P<0.05). A significant correlation was found between ECV and CVF (r=0.64, P=0.020), whereas the correlation between GLS and CVF was insignificant. Significant correlations were observed between GLS and LV mass index (r=0.72, P=0.006) and LVEF (r=0.82, P<0.001). However, no correlations were found between ECV and LV mass index (P=0.172) and between ECV and LVEF (P=0.339). Discrimination of patients with preserved LVEF from controls, GLS yielded the best diagnostic performance as defined by the area of under the curve (-0.83), and GLS, ECV, and post-T1 were significant discriminators after regression analysis. CONCLUSIONS: In the process of LV extracellular remodeling in severe AS, ECV is the structural marker of extracellular fibrosis burden, and GLS is the functional marker before the fibrosis burden intensifies. 2020 Cardiovascular Diagnosis and Therapy. All rights reserved.
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