Endocardial Remodeling in Heart Failure Patients with Impaired and Preserved Left Ventricular Systolic Function--A
Lian-Yu Lin1, Mao-Yuan M Su2, Van-Truong Pham3
1Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Left ventricular trabeculation increases in systolic heart failure (SHF) patients, linked to myocardial hypertrophy and fibrosis. Trabecular-papillary muscle mass rises during heart failure remodeling.
Area of Science:
- Cardiology
- Medical Imaging
- Heart Failure Research
Background:
- Left ventricular (LV) trabeculation is recognized in some cardiomyopathies.
- LV endocardial trabeculation changes during heart failure (HF) remodeling remain poorly understood.
Purpose of the Study:
- To investigate LV endocardial trabeculation changes in heart failure.
- To correlate trabecular-papillary muscle (TPM) mass, fractal dimension (FD), and extracellular volume (ECV) with different HF types and LV remodeling.
Main Methods:
- Prospective enrollment of 74 systolic heart failure (SHF), 65 heart failure with preserved ejection fraction (HFpEF), and 61 non-HF subjects.
- Cardiac magnetic resonance imaging (MRI) including cine, T1, and late gadolinium enhancement (LGE) sequences.
- Quantification of TPM mass, LV mass (LVM), FD, and ECV.
Main Results:
- TPM mass index and TPM to LV mass ratio (TPMm/LVM) were significantly higher in SHF patients compared to HFpEF and non-HF groups.
- LGE presence was inversely associated with TPM mass index and TPMm/LVM.
- ECV showed a positive association with TPMm/LVM, while FD correlated positively with LV chamber size but not HF severity.
Conclusions:
- TPM mass increases in SHF, likely due to myocardial hypertrophy and fibrotic repair during cardiac remodeling.
- LV chamber dilatation is associated with increased FD, but FD remains stable despite LV function decline.
Abstract:
Left ventricular (LV) trabeculation has been studied in certain forms of cardiomyopathy. However, the changes of LV endocardial trabeculation during the remodeling process leading to heart failure (HF) are unclear. Seventy-four patients with systolic heart failure (SHF), 65 with heart failure with preserved ejection fraction (HFpEF) and 61 without HF were prospectively enrolled. All subjects received magnetic resonance imaging (MRI) study including cine, T1 and late gadolinium enhancement (LGE) images. Trabecular-papillary muscle (TPM) mass, fractal dimension (FD) and extracellular volume (ECV) were derived. The results showed that TPM mass index was higher in patients with SHF than that in patients with HFpEF and non-HF. The TPM mass-LV mass ratio (TPMm/LVM) was higher in SHF group than that in HFpEF and non-HF. FD was not different among groups. The presence of LGE was inversely associated with TPM mass index and TPMm/LVM while the ECV were positively associated with TPMm/LVM. The FD was positively associated with LV chamber size. In conclusion, TPM increases in patients with SHF and are probably related to myocardial cell hypertrophy and fibrotic repair during remodeling. The FD increases with the dilatation of LV chamber but remain unchanged with the deterioration of LV function.
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