Key result
Diffuse myocardial fibrosis on CMR T1 mapping strongly correlates with invasive passive LV stiffness.
Why the study?
The precise mechanism of LV diastolic dysfunction in the presence of myocardial fibrosis has not previously been established.
Does diffuse myocardial fibrosis evaluated by post-contrast T1 mapping correlate with invasive left ventricular stiffness in cardiac transplant recipients?
Cross-Sectional (n=20)
Does diffuse myocardial fibrosis evaluated by post-contrast T1 mapping correlate with invasive left ventricular stiffness in cardiac transplant recipients?
Effect estimate: r = -0.71
p-value: p=0.001
Diffuse myocardial fibrosis assessed by CMR T1 mapping correlates with invasively measured passive LV stiffness, suggesting it is a major contributor to diastolic dysfunction in cardiac transplant recipients.
Hypothesis-generating for T1 mapping in transplant diastolic dysfunction; prospective validation needed before clinical adoption.
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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Ellims et al. (2014) conducted a cross-sectional in Cardiac transplant recipients (n=20). Diffuse myocardial fibrosis (post-contrast myocardial T1 time and extracellular volume fraction) was evaluated on Correlation with β, the load-independent passive LV stiffness constant (r = -0.71, p=0.001). Diffuse myocardial fibrosis, assessed by post-contrast myocardial T1 time, correlated significantly with invasively-demonstrated passive LV stiffness (r = -0.71, p = 0.001).
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