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"Interstitial fibrosis is associated with left atrial remodeling and adverse clinical outcomes in selected low-risk patients with hypertrophic cardiomyopathy".
Tondi, Lara; Pica, Silvia; Crimi, Gabriele; Disabato, Giandomenico; Figliozzi, Stefano; Camporeale, Antonia; Bernardini, Andrea; Tassetti, Luigi; Milani, Valentina; Piepoli, Massimo Francesco; Lombardi, Massimo.
Afiliação
  • Tondi L; Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. Electronic address: tondi.lara@gmail.com.
  • Pica S; Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
  • Crimi G; Interventional Cardiology, Cardio Thoraco-Vascular-Department, IRCCS Policlinico San Martino, Genoa, Italy.
  • Disabato G; Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
  • Figliozzi S; Cardio Center, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy.
  • Camporeale A; Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. Electronic address: antonia.camporeale@grupposandonato.it.
  • Bernardini A; Cardiology and Electrophysiology Unit, Santa Maria Nuova Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. Electronic address: andrea.bernardini@uslcentro.toscana.it.
  • Tassetti L; Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
  • Milani V; Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. Electronic address: valentina.milani@grupposandonato.it.
  • Piepoli MF; Clinical Cardiology, IRCCS Policlinico San Donato, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy. Electronic address: massimo.piepoli@grupposandonato.it.
  • Lombardi M; Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. Electronic address: massimo.lombardi@grupposandonato.it.
Int J Cardiol ; 408: 132135, 2024 Aug 01.
Article em En | MEDLINE | ID: mdl-38705206
ABSTRACT

BACKGROUND:

Cardiovascular magnetic resonance (CMR) extracellular volume (ECV) allows non-invasive detection of myocardial interstitial fibrosis, which may be related to diastolic dysfunction and left atrial (LA) remodeling in hypertrophic cardiomyopathy (HCM). While the prognostic role of LGE is well-established, interstitial fibrosis and LA dysfunction are emerging novel markers in HCM. This study aimed to explore the interaction between interstitial fibrosis by ECV, LA morpho-functional parameters and adverse clinical outcomes in selected low-risk patients with HCM.

METHODS:

115 HCM patients and 61 matched controls underwent CMR to identify i) interstitial fibrosis by ECV in hypertrophied left ventricular LGE-negative remote myocardium (r-ECV); ii) LA indexed maximum (LAVi max) and minimum (LAVi min) volumes, ejection fraction (LA-EF) and strain (reservoir εs, conduit εe and booster εa), by CMR feature-tracking. 2D-echocardiographic assessment of diastolic function was also performed within 6 months from CMR. A composite endpoint including worsening NYHA class, heart failure hospitalization, atrial fibrillation and all-cause death was evaluated at 2.3 years follow-up. HCM patients were divided into two groups, according to r-ECV values of controls.

RESULTS:

Patients with r-ECV ≥29% (n = 45) showed larger LA volumes (LAVimax 63 vs. 54 ml/m2, p < 0.001; LAVimin 43 vs. 28 ml/m2, p ã€ˆ0001), worse LA function (εs 16 vs. 28%, εe 8 vs. 15%, εa 8 vs. 14%, LA-EF 33 vs. 49%, all p < 0.001) and elevated Nt-proBNP (1115 vs. 382 pg/ml, p = 0.002). LA functional parameters inversely correlated with r-ECV (εs r = -0.54; LA-EF r = -0.46; all p < 0.001) and E/e' (εs r = -0.52, LA-EF r = -0.46; all p < 0.006). r-ECV ≥29% and LAVi min >30 ml/m2 have been identified as possible independent factors associated with the endpoint.

CONCLUSIONS:

In HCM diffuse interstitial fibrosis detected by increased r-ECV is associated with LA remodeling and emerged as a potential independent predictor of adverse clinical outcomes, on top of the well-known prognostic impact of LGE.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cardiomiopatia Hipertrófica / Fibrose / Imagem Cinética por Ressonância Magnética / Remodelamento Atrial Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Int J Cardiol Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cardiomiopatia Hipertrófica / Fibrose / Imagem Cinética por Ressonância Magnética / Remodelamento Atrial Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Int J Cardiol Ano de publicação: 2024 Tipo de documento: Article