Author + information
- Received September 21, 2015
- Revision received February 2, 2016
- Accepted February 9, 2016
- Published online April 19, 2016.
- Karl-Philipp Rommel, MDa,
- Maximilian von Roeder, MDa,
- Konrad Latuscynski, BSca,
- Christian Oberueck, BSca,
- Stephan Blazek, MDa,
- Karl Fengler, MDa,
- Christian Besler, MDa,
- Marcus Sandri, MDa,
- Christian Lücke, MDb,
- Matthias Gutberlet, MDb,
- Axel Linke, MDa,
- Gerhard Schuler, MDa and
- Philipp Lurz, MD, PhDa,∗ ()
- aDepartment of Internal Medicine/Cardiology, Leipzig University, Heart Center, Leipzig, Germany
- bDepartment of Radiology, Leipzig University, Heart Center, Leipzig, Germany
- ↵∗Reprint requests and correspondence:
Dr. Philipp Lurz, Department of Internal Medicine/Cardiology, Heart Center of the University of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany.
Background Optimal patient characterization in heart failure with preserved ejection fraction (HFpEF) is essential to tailor successful treatment strategies. Cardiac magnetic resonance (CMR)–derived T1 mapping can noninvasively quantify diffuse myocardial fibrosis as extracellular volume fraction (ECV).
Objectives This study aimed to elucidate the diagnostic performance of T1 mapping in HFpEF by examining the relationship between ECV and invasively measured parameters of diastolic function. It also investigated the potential of ECV to differentiate among pathomechanisms in HFpEF.
Methods We performed T1 mapping in 24 patients with HFpEF and 12 patients without heart failure symptoms. Pressure-volume loops were obtained with a conductance catheter during basal conditions and handgrip exercise. Transient pre-load reduction was used to extrapolate the diastolic stiffness constant.
Results Patients with HFpEF showed higher ECV (p < 0.01), elevated load-independent passive left ventricular (LV) stiffness constant (beta) (p < 0.001), and a longer time constant of active LV relaxation (p = 0.02). ECV correlated highly with beta (r = 0.75; p < 0.001). Within the HFpEF cohort, patients with ECV greater than the median showed a higher beta (p = 0.05), whereas ECV below the median identified patients with prolonged active LV relaxation (p = 0.01) and a marked hypertensive reaction to exercise due to pathologic arterial elastance (p = 0.04). On multiple linear regression analyses, ECV independently predicted intrinsic LV stiffness (β = 0.75; p < 0.01).
Conclusions Diffuse myocardial fibrosis, assessed by CMR-derived T1 mapping, independently predicts invasively measured LV stiffness in HFpEF. Additionally, ECV helps to noninvasively distinguish the role of passive stiffness and hypertensive exercise response with impaired active relaxation. (Left Ventricular Stiffness vs. Fibrosis Quantification by T1 Mapping in Heart Failure With Preserved Ejection Fraction [STIFFMAP]; NCT02459626)
This study was funded by a research grant from the Heart Center, Leipzig. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 21, 2015.
- Revision received February 2, 2016.
- Accepted February 9, 2016.
- 2016 American College of Cardiology Foundation