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Volume 18 Supplement 1

19th Annual SCMR Scientific Sessions

Extracellular volume fraction correlates with myocardial stiffness and allows for differentiation between impaired active relaxation and passive stiffness in heart failure with preserved ejection fraction

Background

Optimal patients characterization in Heart Failure with Preserved Ejection Fraction (HFpEF) is essential to tailor successful treatment strategies.

Cardiac magnetic resonance derived T1-Mapping allows for non-invasive quantification of diffuse myocardial fibrosis as extracellular volume fraction (ECV).

We aimed to elucidate the diagnostic performance of T1-Mapping in HFpEF by examining the relationship between ECV and invasively measured parameters of diastolic function and investigated the potential of ECV to differentiate between different pathomechanisms in HFpEF.

Methods

We performed T1-Mapping in 21 patients with HFpEF and 11 patients without heart failure symptoms. Pressure-volume-loops were obtained with a conductance catheter during basal conditions and handgrip exercise. Transient preload reduction was used to extrapolate the diastolic stiffness constant.

Results

Patients with HFpEF showed a higher ECV (p = 0.001), an elevated load-independent passive LV-stiffness-constant β (p < 0.001) and a longer time constant of active LV-relaxation τ (p = 0.04). ECV correlated highly with β (r = 0.75, p <0.001). After multivariate analysis, ECV remained the only independent predictor of β.

Within the HFpEF cohort, patients with ECV > median showed a higher LV-stiffness-constant (p = 0.05) whereas ECV < median identified patients with a prolonged active LV-relaxation (p = 0.01) and a marked hypertensive reaction to exercise due to a pathologic arterial elastance (p = 0.05).

Conclusions

Diffuse myocardial fibrosis, assessed by CMR derived T1-Mapping, independently predicts invasively measured LV stiffness in HFpEF. In addition, ECV helps to non-invasively distinguish the role of impaired active relaxation and passive stiffness. It also refines characterization of patients, which represents a prerequisite for any successful therapy in the future.

Figure 1
figure1

Results of pressure volume analysis, echocardiography and CMR-imaging according to ECV group and controls.

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Correspondence to Karl-Philipp Rommel.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Rommel, K., Roeder, M.v., Stiermaier, T. et al. Extracellular volume fraction correlates with myocardial stiffness and allows for differentiation between impaired active relaxation and passive stiffness in heart failure with preserved ejection fraction. J Cardiovasc Magn Reson 18, Q66 (2016). https://doi.org/10.1186/1532-429X-18-S1-Q66

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Keywords

  • Cardiac Magnetic Resonance
  • Heart Failure With Preserve Ejection Fraction
  • Preserve Ejection Fraction
  • Arterial Elastance
  • Handgrip Exercise