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Relation of replacement fibrosis to left ventricular diastolic function in patients with dilated cardiomyopathy

Adham N Malaty1, Dipan J Shah, Ahmed R Abdelkarim

  • 1Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX, USA.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|February 23, 2011
PubMed

Insights

In dilated cardiomyopathy (DCM), left ventricular (LV) stiffness is not solely determined by fibrosis. Patients without late gadolinium enhancement (LVE) show higher LV filling pressures, suggesting other factors influence stiffness.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Cardiac Physiology

Background:

  • Delayed hyperenhancement (HE) on cardiac magnetic resonance (CMR) correlates with left ventricular (LV) stiffness in various heart diseases.
  • The relationship between HE and LV stiffness in dilated cardiomyopathy (DCM), where fibrosis is less pronounced, remains unclear.

Purpose of the Study:

  • To investigate the association between HE, indicative of myocardial scarring, and LV diastolic function in patients with DCM.
  • To determine if replacement fibrosis is a primary determinant of LV stiffness in DCM.

Main Methods:

  • Fifty DCM patients underwent CMR and echocardiography.
  • CMR assessed LV ejection fraction, atrial volume, and scar burden using late gadolinium enhancement (LGE).
  • Echocardiography evaluated LV diastolic function via mitral inflow and tissue Doppler velocities.

Main Results:

  • 31 patients (62%) showed HE with a mean scar burden of 4%.
  • Patients without HE exhibited significantly higher septal E/e' ratios, indicating elevated LV filling pressures.
  • Scar burden showed a weak inverse correlation with lateral annular diastolic velocity (a'), suggesting a limited role in diastolic dysfunction.

Conclusions:

  • DCM patients without HE present with higher LV filling pressures compared to those with HE.
  • These findings suggest that factors beyond replacement fibrosis significantly influence LV stiffness in DCM.
Abstract

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