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Assessment of Cardiac Morphological and Functional Changes in Mouse Model of Transverse Aortic Constriction by Echocardiographic Imaging
Published on: June 21, 2016
Non-invasive tissue characterization in children and young adults with aortic coarctation-an MRI-based prospective
Tobias Giertzsch1, Michael Jerosch-Herold2, Philipp Schneider3
1Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
Severe aortic coarctation (CoA) is linked to elevated myocardial extracellular volume fraction (ECV) and native T1, indicating adverse tissue remodeling. Patients with CoA, particularly severe cases or those with bicuspid aortic valve (BAV), face higher long-term risks for heart complications.
Area of Science:
- Cardiovascular Imaging
- Cardiac MRI
- Myocardial Tissue Characterization
Background:
- Aortic coarctation (CoA) requires lifelong monitoring for late complications like re-stenosis, aneurysms, arrhythmias, and heart failure.
- Understanding adverse left-ventricular (LV) remodeling at the myocardial tissue level is crucial for predicting incipient heart failure in CoA patients.
Purpose of the Study:
- To assess myocardial tissue characteristics in CoA patients using advanced cardiac magnetic resonance (CMR) imaging.
- To identify markers of adverse tissue remodeling and their correlation with disease severity, bicuspid aortic valve (BAV), and blood pressure (BP) medication use.
Main Methods:
- Utilized 3 Tesla CMR imaging to measure myocardial extracellular volume fraction (ECV), native T1, and intracellular water lifetime (τic) via T1 mapping in 46 CoA patients and 14 controls.
- Classified CoA into low grade (LG), severe (sCoA), and CoA with BAV based on flow velocity, re-stenosis, hypertension, and medication.
- Acquired LV volumes, mass, and ejection fraction from cine CMR sequences.
Main Results:
- Severe CoA (sCoA) and CoA with BAV showed significantly higher ECV and native T1 values compared to LG CoA and healthy controls, indicating increased myocardial fibrosis.
- Intracellular water lifetime (τic) was lower in LG CoA, suggesting smaller cardiomyocyte diameter, compared to sCoA and CoA with BAV.
- Elevated LV end-systolic volume (ESV) was observed in the BAV group compared to LG and sCoA groups. Antihypertensive medication was associated with lower native T1 and τic.
Conclusions:
- Severe CoA is associated with elevated myocardial ECV and native T1, reflecting adverse tissue remodeling and increased long-term risk for heart failure, diastolic dysfunction, and arrhythmias.
- Concomitant BAV in LG CoA patients indicates greater diffuse myocardial fibrosis compared to isolated LG CoA.
- Antihypertensive therapy may mitigate adverse remodeling, reducing cardiomyocyte hypertrophy and interstitial fibrosis in CoA patients.
Background:
Aortic coarctation (CoA) necessitates long-term monitoring to identify late complications, including re-stenosis, aneurysms, arrhythmias and heart failure. Nonetheless, there remain gaps in understanding the effects of adverse left-ventricular (LV) remodeling at the myocardial tissue level, which may contribute to incipient heart failure. The aim of this study is to evaluate myocardial tissue characteristics in patients with CoA using advanced cardiac magnetic resonance (CMR) imaging techniques to identify markers of adverse tissue remodeling and their association with disease severity, bicuspid aortic valve (BAV), and clinical management strategies such as blood pressure (BP) medication.
Methods:
CMR imaging at 3 Tesla was used to determine the myocardial extracellular volume fraction (ECV), native T1, and intracellular water lifetime (τic) by pre- and post-gadolinium contrast T1 mapping in 46 patients (21 male; mean age 20 years) with CoA and 14 age-matched controls. LV volumes, mass, and ejection fraction were obtained from cine CMR. CoA was classified as low grade ["LG" = the maximum flow velocity (Vmax) ≤3 m/s and no re-stenosis, nor arterial hypertension or medication], severe CoA ("sCoA" = Vmax >3 m/s or one of LG's other variables applies), and "CoA with BAV".
Results:
ECV was significantly higher in sCoA group (0.31±0.04) compared to LG group (0.26±0.02, P=0.002) and healthy controls (0.26±0.02, P=0.001). ECV with BAV (0.31±0.05) was higher than in LG group (P=0.03) and healthy controls (P=0.03). Native T1 values were significantly elevated in sCoA group (T1 =1,391±162 ms) compared to LG group (T1 =1,213±47 ms, P=0.002) and in CoA with BAV (T1 =1,390±127 ms) versus LG group (P=0.002). τic was lower in LG group (0.24±0.03 s), indicative of a smaller cardiomyocyte diameter, compared to sCoA (0.28±0.04 s; P=0.01) and LG CoA with concomitant BAV (0.31±0.05 s; P=0.04). The LV end-systolic volume (ESV) was significantly higher in group with BAV than in LG CoA (P<0.001) and sCoA (P=0.001) groups. Patients who took BP medication had significantly lower values in native T1 (P=0.02) and τic (P=0.03).
Conclusions:
sCoA is associated with an elevated myocardial ECV and native T1 compared to LG CoAs and healthy controls, reflecting adverse tissue remodeling. Patients with LG CoA and concomitant BAV showed significantly greater diffuse myocardial fibrosis than those with isolated LG CoA. CoA patients, especially those with sCoA and those with concomitant BAV, could be at increased long-term risk for complications related to diffuse myocardial fibrosis, such as diastolic dysfunction and arrhythmias. Patients taking antihypertensive medication may benefit from reduced cardiomyocyte hypertrophy and less interstitial fibrosis.
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