What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: General population without known coronary artery disease (n=200). Intervention: Focal myocardial fibrosis (LGE presence) vs. No focal myocardial fibrosis. Primary outcome: Global longitudinal strain (GLS) (β = 0.83, 95% CI 0.02-1.63, p=<0.05).

What question did this study set out to answer?

This research explores how myocardial fibrosis affects left ventricular deformation and synchrony in the elderly.

June 19, 2026The International Journal of Cardiovascular Imaging0 citationsOpen Access

Myocardial fibrosis is associated with worse left ventricular strain and synchrony assessed by novel CMR imaging in the general population: data from the Akershus Cardiac examination 1950 study

Q: What are the key findings of this study?

In an elderly general population without known coronary artery disease, the presence of focal myocardial scars was associated with worse global longitudinal strain (β = 0.83) and increased odds of high mechanical dispersion.

Q: What question did this study set out to answer?

This research explores how myocardial fibrosis affects left ventricular deformation and synchrony in the elderly.

TWThakshani WimalanathanUniversity of Oslo JSJoanna SulkowskaUniversity of Oslo AMA. MellesAkershus University Hospital

Key Result

In an elderly general population without known coronary artery disease, the presence of focal myocardial scars was associated with worse global longitudinal strain (β = 0.83) and increased odds of high mechanical dispersion.

Key Points

This research explores how myocardial fibrosis affects left ventricular deformation and synchrony in the elderly.
Participants: 200 individuals without known coronary artery disease, aged 69, born in 1950.
Fibrosis quantified through extracellular volume fraction and late gadolinium enhancement using cardiac magnetic resonance imaging.
Associations were examined using regression analyses.
Focal fibrosis linked to worse global longitudinal strain (GLS) with presence β = 0.83, 95% CI 0.02 to 1.63; volume β = 0.17, 95% CI 0.04 to 0.30.
ECV values above 26% correlated with worse GLS and lower fSENC percentage of normal myocardium.
Participants with focal scars showed higher median mechanical dispersion (MD) (89.0 ms vs 78.0 ms).

Study Design

Type

Cross-Sectional (n=200)

Multicenter

Structured PICO

Is myocardial fibrosis associated with worse left ventricular strain and mechanical synchrony in an elderly general population?

Population

200 community-dwelling adults aged approximately 69 years without known coronary artery disease, who underwent cardiac magnetic resonance imaging to assess myocardial fibrosis and strain.

Exposure

Myocardial fibrosis quantified by septal extracellular volume (ECV) fraction and focal fibrosis by late gadolinium enhancement (LGE) using cardiac magnetic resonance imaging (CMR)

Outcome

Left ventricular (LV) deformation and mechanical synchrony (LV global longitudinal and circumferential strain (GLS, GCS) and mechanical dispersion (MD) derived by CMR-feature tracking, and fast strain-encoded MR (fSENC) percentage of LV segments with normal strain)surrogate

In an elderly general population without known coronary artery disease, focal and diffuse myocardial fibrosis assessed by CMR are associated with worse LV deformation and mechanical synchrony.

Main Result

Mean Difference: 0.83 (95% CI 0.02–1.63)

p-value: p=<0.05

Limitations

Cross-sectional nature prevents causal inference between fibrosis and cardiac function
Mechanical dispersion assessed by CMR and fSENC are emerging imaging biomarkers needing validation in other cohorts
Limited number of participants with focal scars or elevated ECV levels may have reduced statistical power
Using a septal measure for ECV may fail to capture regional variations in diffuse fibrosis distribution
Interim cardiovascular disease between baseline (5-7 years prior) and CMR was not accounted for
Combining ischemic and non-ischemic scar types limits mechanistic interpretation
Older Caucasian cohort limits generalizability to a multiethnic population covering a wider age range

Abstract

Investigate the relationship between myocardial fibrosis and left ventricular (LV) deformation and mechanical synchrony using state-of-the-art cardiac magnetic resonance imaging (CMR) in an elderly general population. In 200 participants without known coronary artery disease, all born in 1950, diffuse fibrosis was quantified by septal extracellular volume (ECV) fraction and focal fibrosis by late gadolinium enhancement (LGE). LV global longitudinal and circumferential strain (GLS, GCS) and mechanical dispersion (MD) were derived by CMR-feature tracking (CMR-FT). Myocardial deformation was also assessed using fast strain-encoded MR (fSENC) percentage of LV segments with normal longitudinal and circumferential strain (≤ -17%). The associations between myocardial fibrosis and bothstrain and mechanical dispersion were examined using regression analyses. Median age was 69.0 (interquartile range (IQR) 68.6–69.3) years and 52% were male. In adjusted models, LGE presence and volume were associated with worse GLS (presence: β = 0.83, 95% CI 0.02 to 1.63; volume: β = 0.17, 95% CI 0.04 to 0.30) and lower fSENC % normal myocardium (presence: β = -6.68, 95% CI -13.33 to -0.04; volume: β = -1.66, 95% CI -3.14 to -0.18). The association between LGE (presence and volume) and GCS was attenuated when adjusting for indexed LV end diastolic volume. ECV values above 26% were associated with worse GLS, GCS and lower fSENC % normal myocardium. Participants with focal scars had significantly higher median MD (89.0 ms (IQR 71.2, 121.1) vs 78.0 ms (IQR 60.4, 97.3)), and focal scars were associated with MD above the sex specific upper quartile (OR 2.64, 95% CI (1.18, 5.94) for LGE presence and 1.22, 95% CI (1.05, 1.42) for LGE volume). In this elderly general population, focal myocardial fibrosis was associated with worse LV deformation and synchrony. There was a threshold effect with a non-linear association between diffuse fibrosis and strain.

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