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Relation of Left Ventricular Diastolic Function to Global Fibrosis Burden: Implications for Heart Failure Risk

David Lewandowski1, Eric Y Yang2, Duc T Nguyen3

  • 1Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.

JACC. Cardiovascular Imaging
|April 11, 2023
PubMed

Insights

Cardiac magnetic resonance (CMR) detects fibrosis, improving prognosis prediction beyond echocardiography for left ventricular (LV) diastolic dysfunction. This enhances risk stratification for mortality and heart failure hospitalizations.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Echocardiography is standard for assessing left ventricular (LV) diastolic function but has limitations in detecting myocardial fibrosis.
  • Cardiac magnetic resonance (CMR) excels at detecting and quantifying cardiac fibrosis.

Purpose of the Study:

  • To investigate the association between LV diastolic function assessed by echocardiography and CMR-determined global fibrosis.
  • To evaluate the incremental prognostic value of fibrosis in predicting mortality and heart failure hospitalizations when combined with diastolic function grading.

Main Methods:

  • 549 patients underwent concurrent echocardiography and CMR within 30 days.
  • Echocardiography assessed LV diastolic function; CMR quantified LV volumes, mass, ejection fraction, replacement fibrosis, and extracellular volume fraction (ECV).

Main Results:

  • Patients with diastolic dysfunction had higher event rates (33.4%) than those with normal function (15.5%).
  • Adding global fibrosis burden to LV diastolic function grades II and III improved prediction of composite outcomes (C-statistic 0.74) and heart failure hospitalizations (C-statistic 0.80).

Conclusions:

  • Increased grades of diastolic dysfunction correlate with replacement fibrosis and elevated ECV.
  • CMR-determined fibrosis burden offers significant incremental prognostic information beyond echocardiographic assessment of LV diastolic function.
Abstract

Keywords:
cardiac magnetic resonancediastoleechocardiographyfibrosis

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