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Myocardial Fibrosis Quantified by Extracellular Volume Is Associated With Subsequent Hospitalization for Heart

Erik B Schelbert1, Kayla M Piehler2, Karolina M Zareba3

  • 1Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (E.B.S., K.M.Z., C.C.H.C., T.C.W.) UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA (E.B.S., K.M.P., K.M.Z., T.C.W.) Clinical and Translational Science Institute, University of Pittsburgh, PA (E.B.S., T.C.W.).

Journal of the American Heart Association
|December 20, 2015
PubMed

Insights

Myocardial fibrosis (MF), measured by extracellular volume fraction (ECV), predicts heart failure hospitalization and death. This finding offers new therapeutic targets for cardiac vulnerability.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Biomarkers

Background:

  • Myocardial fibrosis (MF) in noninfarcted areas is linked to heart failure hospitalizations and mortality.
  • Predicting and preventing heart failure hospitalizations remains a significant challenge.

Purpose of the Study:

  • To quantify MF using cardiovascular magnetic resonance (CMR) extracellular volume fraction (ECV).
  • To assess the association between ECV-measured MF and adverse cardiovascular outcomes.

Main Methods:

  • 1172 patients without specific cardiomyopathies underwent CMR for ECV quantification.
  • Cox regression analysis was used to evaluate associations between ECV and outcomes over a median follow-up of 1.7 years.

Main Results:

  • Higher ECV was significantly associated with increased risk of heart failure hospitalization (HR 1.77), death (HR 1.87), and combined events (HR 1.85).
  • ECV demonstrated superior association with outcomes compared to late gadolinium enhancement for nonischemic MF.
  • ECV improved risk classification and model discrimination for adverse outcomes.

Conclusions:

  • ECV-quantified myocardial fibrosis is a significant predictor of heart failure hospitalization and mortality.
  • MF may represent a key phenotype of cardiac vulnerability, enhancing risk stratification.
  • Reversibility of MF suggests potential therapeutic targets in collagen-regulating pathways.
Abstract

Keywords:
T1 mappingcardiovascular magnetic resonanceextracellular matrixextracellular volume fractionheart failuremyocardial fibrosis

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