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Association between left ventricular mechanics and diffuse myocardial fibrosis in patients with repaired Tetralogy of Fallot: a cross-sectional study.
J Cardiovasc Magn Reson. 2017 Dec 11; 19(1):100.JC

Abstract

BACKGROUND

Patients with repaired tetralogy of Fallot (TOF) have progressive, adverse biventricular remodeling, leading to abnormal contractile mechanics. Defining the mechanisms underlying this dysfunction, such as diffuse myocardial fibrosis, may provide insights into poor long-term outcomes. We hypothesized that left ventricular (LV) diffuse fibrosis is related to impaired LV mechanics.

METHODS

Patients with TOF were evaluated with cardiac magnetic resonance in which modified Look-Locker (MOLLI) T1-mapping and spiral cine Displacement encoding (DENSE) sequences were acquired at three LV short-axis positions. Linear mixed modeling was used to define the association between regional LV mechanics from DENSE based on regional T1-derived diffuse fibrosis measures, such as extracellular volume fraction (ECV).

RESULTS

Forty patients (26 ± 11 years) were included. LV ECV was generally within normal range (0.24 ± 0.05). For LV mechanics, peak circumferential strains (-15 ± 3%) and dyssynchrony indices (16 ± 8 ms) were moderately impaired, while peak radial strains (29 ± 8%) were generally normal. After adjusting for patient age, sex, and regional LV differences, ECV was associated with log-adjusted LV dyssynchrony index (β = 0.67) and peak LV radial strain (β = -0.36), but not LV circumferential strain. Moreover, post-contrast T1 was associated with log-adjusted LV diastolic circumferential strain rate (β = 0.37).

CONCLUSIONS

We observed several moderate associations between measures of fibrosis and impaired mechanics, particularly the LV dyssynchrony index and peak radial strain. Diffuse fibrosis may therefore be a causal factor in some ventricular dysfunction in TOF.

Authors+Show Affiliations

Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA, 17822-4400, USA. chaggerty3@gatech.edu. Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA. chaggerty3@gatech.edu.Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA, 17822-4400, USA. Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA.Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA, 17822-4400, USA. Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA.Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA, 17822-4400, USA. Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA.Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA.Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA, 17822-4400, USA. Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA.Department of Biostatistics, University of Kentucky, Lexington, KY, USA.Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA, 17822-4400, USA. Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA. Department of Radiology, Geisinger, Danville, PA, USA.Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29228952

Citation

Haggerty, Christopher M., et al. "Association Between Left Ventricular Mechanics and Diffuse Myocardial Fibrosis in Patients With Repaired Tetralogy of Fallot: a Cross-sectional Study." Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance, vol. 19, no. 1, 2017, p. 100.
Haggerty CM, Suever JD, Pulenthiran A, et al. Association between left ventricular mechanics and diffuse myocardial fibrosis in patients with repaired Tetralogy of Fallot: a cross-sectional study. J Cardiovasc Magn Reson. 2017;19(1):100.
Haggerty, C. M., Suever, J. D., Pulenthiran, A., Mejia-Spiegeler, A., Wehner, G. J., Jing, L., Charnigo, R. J., Fornwalt, B. K., & Fogel, M. A. (2017). Association between left ventricular mechanics and diffuse myocardial fibrosis in patients with repaired Tetralogy of Fallot: a cross-sectional study. Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance, 19(1), 100. https://doi.org/10.1186/s12968-017-0410-2
Haggerty CM, et al. Association Between Left Ventricular Mechanics and Diffuse Myocardial Fibrosis in Patients With Repaired Tetralogy of Fallot: a Cross-sectional Study. J Cardiovasc Magn Reson. 2017 Dec 11;19(1):100. PubMed PMID: 29228952.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between left ventricular mechanics and diffuse myocardial fibrosis in patients with repaired Tetralogy of Fallot: a cross-sectional study. AU - Haggerty,Christopher M, AU - Suever,Jonathan D, AU - Pulenthiran,Arichanah, AU - Mejia-Spiegeler,Abba, AU - Wehner,Gregory J, AU - Jing,Linyuan, AU - Charnigo,Richard J, AU - Fornwalt,Brandon K, AU - Fogel,Mark A, Y1 - 2017/12/11/ PY - 2017/03/19/received PY - 2017/11/20/accepted PY - 2017/12/13/entrez PY - 2017/12/13/pubmed PY - 2018/8/7/medline KW - DENSE KW - MOLLI KW - Strain KW - T1 mapping KW - Tetralogy of Fallot SP - 100 EP - 100 JF - Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance JO - J Cardiovasc Magn Reson VL - 19 IS - 1 N2 - BACKGROUND: Patients with repaired tetralogy of Fallot (TOF) have progressive, adverse biventricular remodeling, leading to abnormal contractile mechanics. Defining the mechanisms underlying this dysfunction, such as diffuse myocardial fibrosis, may provide insights into poor long-term outcomes. We hypothesized that left ventricular (LV) diffuse fibrosis is related to impaired LV mechanics. METHODS: Patients with TOF were evaluated with cardiac magnetic resonance in which modified Look-Locker (MOLLI) T1-mapping and spiral cine Displacement encoding (DENSE) sequences were acquired at three LV short-axis positions. Linear mixed modeling was used to define the association between regional LV mechanics from DENSE based on regional T1-derived diffuse fibrosis measures, such as extracellular volume fraction (ECV). RESULTS: Forty patients (26 ± 11 years) were included. LV ECV was generally within normal range (0.24 ± 0.05). For LV mechanics, peak circumferential strains (-15 ± 3%) and dyssynchrony indices (16 ± 8 ms) were moderately impaired, while peak radial strains (29 ± 8%) were generally normal. After adjusting for patient age, sex, and regional LV differences, ECV was associated with log-adjusted LV dyssynchrony index (β = 0.67) and peak LV radial strain (β = -0.36), but not LV circumferential strain. Moreover, post-contrast T1 was associated with log-adjusted LV diastolic circumferential strain rate (β = 0.37). CONCLUSIONS: We observed several moderate associations between measures of fibrosis and impaired mechanics, particularly the LV dyssynchrony index and peak radial strain. Diffuse fibrosis may therefore be a causal factor in some ventricular dysfunction in TOF. SN - 1532-429X UR - https://www.unboundmedicine.com/medline/citation/29228952/Association_between_left_ventricular_mechanics_and_diffuse_myocardial_fibrosis_in_patients_with_repaired_Tetralogy_of_Fallot:_a_cross_sectional_study_ L2 - https://jcmr-online.biomedcentral.com/articles/10.1186/s12968-017-0410-2 DB - PRIME DP - Unbound Medicine ER -