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Published on: February 14, 2017
Measuring mechanical function in the failing heart
1Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD 20892-1061, USA. emcveigh@nih.gov
Insights
Magnetic resonance (MR) imaging techniques quantify mechanical changes in heart failure, aiding diagnosis and predicting treatment response in hypertrophic and dilated cardiomyopathy.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Imaging
Background:
- Heart failure involves detrimental changes in cardiac contraction and filling mechanics.
- Familial hypertrophic cardiomyopathy presents with left ventricular hypertrophy, myofiber disarray, and diastolic dysfunction.
- Dilated cardiomyopathy is associated with asynchronous left ventricular activation, often due to left bundle branch block.
Purpose of the Study:
- To investigate the utility of advanced magnetic resonance (MR) imaging techniques for quantifying mechanical abnormalities in heart failure.
- To assess the role of MR imaging in characterizing diastolic dysfunction in familial hypertrophic cardiomyopathy.
- To evaluate the application of MR imaging in quantifying asynchronous activation in dilated cardiomyopathy and predicting response to resynchronization therapy.
Main Methods:
- Utilized magnetic resonance (MR) tissue tagging, MR cine phase contrast, and MR cine displacement encoding.
- Applied these MR imaging methods to quantify regional myocardial shortening and relaxation.
- Characterized late-activated regions in failing hearts for protein expression analysis.
Main Results:
- MR imaging methods successfully quantified restrictive filling in familial hypertrophic cardiomyopathy.
- Quantified asynchronous activation in dilated cardiomyopathy, correlating with pacing therapy response.
- Enabled measurement of protein expression changes in late-activated myocardial regions.
Conclusions:
- Advanced MR imaging techniques are valuable tools for assessing cardiac mechanics in heart failure.
- These methods aid in understanding disease mechanisms and guiding therapeutic strategies.
- MR imaging can predict response to resynchronization therapy in dilated cardiomyopathy.
Abstract:
A common pathology in heart failure is a detrimental change in the mechanics of both contraction and filling. In familial hypertrophic cardiomyopathy, a genetic disease characterized by left ventricular hypertrophy and myofiber disarray, left ventricular diastolic dysfunction is common and contributes to congestive heart failure. In dilated cardiomyopathy, a common correlate to reduced wall thickening and increased chamber volume is an asynchronous activation of the left ventricle due to left bundle branch block. Local measures of the timing and magnitude of myocardial shortening and relaxation can be obtained with magnetic resonance (MR) tissue tagging, MR cine phase contrast, or MR cine displacement encoding. In familial hypertrophic cardiomyopathy, these methods have been shown to quantify the restrictive filling of the ventricle. Characterizing the regions of the failing heart which are activated late has allowed investigators to measure the change in protein expression in those regions compared to normal myocardium. Also, these MR imaging methods have led to a better quantification of the asynchronous activation in dilated cardiomyopathy, which can be used to predict response to resynchronization therapy with pacing.
