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Myocardial fibrosis quantified by extracellular volume is associated with subsequent hospitalization for heart failure,death,or both across the spectrum of ejection fraction and heart failure stage
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نویسنده
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schelbert e.b. ,piehler k.m. ,zareba k.m. ,moon j.c. ,ugander m. ,messroghli d.r. ,valeti u.s. ,chang c.-c.h. ,shroff s.g. ,diez j. ,miller c.a. ,schmitt m. ,kellman p. ,butler j. ,gheorghiade m. ,wong t.c.
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منبع
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journal of the american heart association - 2015 - دوره : 4 - شماره : 12
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چکیده
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Background-myocardial fibrosis (mf) in noninfarcted myocardium may be an interstitial disease pathway that confers vulnerability to hospitalization for heart failure,death,or both across the spectrum of heart failure and ejection fraction. hospitalization for heart failure is an epidemic that is difficult to predict and prevent and requires potential therapeutic targets associated with outcomes. method and results-we quantified mf with cardiovascular magnetic resonance extracellular volume fraction (ecv) measures in 1172 consecutive patients without amyloidosis or hypertrophic or stress cardiomyopathy and assessed associations with outcomes using cox regression. ecv ranged from 16.6% to 47.8%. over a median of 1.7 years,111 patients experienced events after cardiovascular magnetic resonance,55 had hospitalization for heart failure events,and there were 74 deaths. ecv was more strongly associated with outcomes than nonischemic mf observed with late gadolinium enhancement,thus ecv quantified mf in multivariable models. adjusting for age,sex,renal function,myocardial infarction size,ejection fraction,hospitalization status,and heart failure stage,higher ecv was associated with hospitalization for heart failure (hazard ratio 1.77; 95% ci 1.32 to 2.36 for every 5% increase in ecv),death (hazard ratio 1.87 95% ci 1.45 to 2.40) or both (hazard ratio 1.85,95% ci 1.50 to 2.27). ecv improved classification of persons at risk and improved model discrimination for outcomes (eg,hospitalization for heart failure: continuous net reclassification improvement 0.33,95% ci 0.05 to 0.66; p=0.02; 0.16,95% ci 0.01 to 0.33; p=0.02; integrated discrimination improvement 0.037,95% ci 0.008 to 0.073; p < 0.01). conclusion-mf measured by ecv is associated with hospitalization for heart failure,death,or both. mf may represent a principal phenotype of cardiac vulnerability that improves risk stratification. because mf can be reversible,cells and enzymes regulating collagen could be potential therapeutic targets. © 2015 the authors.
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کلیدواژه
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Cardiovascular magnetic resonance; Extracellular matrix; Extracellular volume fraction; Heart failure; Myocardial fibrosis; T1 mapping
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آدرس
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department of medicine,university of pittsburgh school of medicine,pittsburgh,pa,united states,upmc cardiovascular magnetic resonance center,heart and vascular institute,pittsburgh,pa,united states,clinical and translational science institute,university of pittsburghpa, United States, upmc cardiovascular magnetic resonance center,heart and vascular institute,pittsburgh,pa, United States, department of medicine,university of pittsburgh school of medicine,pittsburgh,pa,united states,upmc cardiovascular magnetic resonance center,heart and vascular institute,pittsburgh,pa,united states,department of medicine,the ohio state university,columbus,oh, United States, barts heart centre and university college london,london, United Kingdom, department of clinical physiology,karolinska institutet,karolinska university hospital,stockholm, Sweden, department of congenital heart disease and pediatric cardiology,deutsches herzzentrum berlin,berlin, Germany, cardiology division,university of minnesota,minneapolis,mn, United States, department of medicine,university of pittsburgh school of medicine,pittsburgh,pa,united states,department of biostatistics,university of pittsburgh,graduate school of public health,pittsburgh,pa, United States, department of bioengineering,university of pittsburghpa, United States, program of cardiovascular diseases,center for applied medical research,university clinic of navarra,pamplona, Spain, centre for imaging sciences,biomedical imaging institute,university of manchester, United Kingdom, centre for imaging sciences,biomedical imaging institute,university of manchester, United Kingdom, national heart,lung and blood institute,bethesda,md, United States, cardiology division,stony brook university,stony brook,ny, United States, center for cardiovascular innovation,northwestern university feinberg school of medicine,chicago,il, United States, department of medicine,university of pittsburgh school of medicine,pittsburgh,pa,united states,upmc cardiovascular magnetic resonance center,heart and vascular institute,pittsburgh,pa,united states,clinical and translational science institute,university of pittsburghpa, United States
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Authors
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