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Effects of myocardial fibrosis assessed by MRI on dynamic left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a retrospective database analysis

BACKGROUND: While implications of myocardial fibrosis on left ventricular (LV) function at rest have been studied in hypertrophic cardiomyopathy (HCM), the pathophysiological consequences on dynamic LV outflow tract (LVOT) gradient have so far not been investigated in detail. OBJECTIVE: To evaluate...

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Autores principales: Biagini, Elena, Lorenzini, Massimiliano, Olivotto, Iacopo, Rocchi, Guido, Lovato, Luigi, Lai, Francesco, Rosmini, Stefania, Pazzi, Chiara, Pasquale, Ferdinando, Reggiani, Maria Letizia Bacchi, Fattori, Rossella, Rapezzi, Claudio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488754/
https://www.ncbi.nlm.nih.gov/pubmed/23065447
http://dx.doi.org/10.1136/bmjopen-2012-001267
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author Biagini, Elena
Lorenzini, Massimiliano
Olivotto, Iacopo
Rocchi, Guido
Lovato, Luigi
Lai, Francesco
Rosmini, Stefania
Pazzi, Chiara
Pasquale, Ferdinando
Reggiani, Maria Letizia Bacchi
Fattori, Rossella
Rapezzi, Claudio
author_facet Biagini, Elena
Lorenzini, Massimiliano
Olivotto, Iacopo
Rocchi, Guido
Lovato, Luigi
Lai, Francesco
Rosmini, Stefania
Pazzi, Chiara
Pasquale, Ferdinando
Reggiani, Maria Letizia Bacchi
Fattori, Rossella
Rapezzi, Claudio
author_sort Biagini, Elena
collection PubMed
description BACKGROUND: While implications of myocardial fibrosis on left ventricular (LV) function at rest have been studied in hypertrophic cardiomyopathy (HCM), the pathophysiological consequences on dynamic LV outflow tract (LVOT) gradient have so far not been investigated in detail. OBJECTIVE: To evaluate the influence of myocardial fibrosis, detected by MRI as late-gadolinium enhancement (LGE), on LVOT gradient in HCM. DESIGN: Retrospective database analysis. SETTING: A single Italian cardiomyopathies referral centre. PATIENTS: Seventy-six HCM patients with normal ejection fraction at rest. INTERVENTIONS: Patients underwent cardiac MR and performed bicycle exercise echocardiogram within a month. RESULTS: LGE was present in 54 patients (71%), ranging from 0.2% to 32.4% of LV mass. There was a weak correlation between the amount of fibrosis and LVOT gradient variation during exercise in the overall population (r=−0.243, p=0.034) and a stronger correlation in patients with obstructive HCM at rest (r=−0.524, p=0.021). Patients with an LVOT gradient increase ≥50 mm Hg during exercise had a significantly lesser extent of fibrosis than those with an increase <50 mm Hg (0.7% (IQR 0–2.4) vs 3.2% (IQR 0.2–7.4), p=0.006). The extent of fibrosis was significantly lower among the highest quartiles of LVOT gradient increase (p=0.009). CONCLUSIONS: In patients with HCM and normal ejection fraction at rest, myocardial fibrosis was associated with a lower increase in LVOT gradient during exercise, probably due to a lesser degree of myocardial contractility recruitment. This negative association was more evident in patients with an obstructive form at rest.
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spelling pubmed-34887542012-11-05 Effects of myocardial fibrosis assessed by MRI on dynamic left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a retrospective database analysis Biagini, Elena Lorenzini, Massimiliano Olivotto, Iacopo Rocchi, Guido Lovato, Luigi Lai, Francesco Rosmini, Stefania Pazzi, Chiara Pasquale, Ferdinando Reggiani, Maria Letizia Bacchi Fattori, Rossella Rapezzi, Claudio BMJ Open Cardiovascular Medicine BACKGROUND: While implications of myocardial fibrosis on left ventricular (LV) function at rest have been studied in hypertrophic cardiomyopathy (HCM), the pathophysiological consequences on dynamic LV outflow tract (LVOT) gradient have so far not been investigated in detail. OBJECTIVE: To evaluate the influence of myocardial fibrosis, detected by MRI as late-gadolinium enhancement (LGE), on LVOT gradient in HCM. DESIGN: Retrospective database analysis. SETTING: A single Italian cardiomyopathies referral centre. PATIENTS: Seventy-six HCM patients with normal ejection fraction at rest. INTERVENTIONS: Patients underwent cardiac MR and performed bicycle exercise echocardiogram within a month. RESULTS: LGE was present in 54 patients (71%), ranging from 0.2% to 32.4% of LV mass. There was a weak correlation between the amount of fibrosis and LVOT gradient variation during exercise in the overall population (r=−0.243, p=0.034) and a stronger correlation in patients with obstructive HCM at rest (r=−0.524, p=0.021). Patients with an LVOT gradient increase ≥50 mm Hg during exercise had a significantly lesser extent of fibrosis than those with an increase <50 mm Hg (0.7% (IQR 0–2.4) vs 3.2% (IQR 0.2–7.4), p=0.006). The extent of fibrosis was significantly lower among the highest quartiles of LVOT gradient increase (p=0.009). CONCLUSIONS: In patients with HCM and normal ejection fraction at rest, myocardial fibrosis was associated with a lower increase in LVOT gradient during exercise, probably due to a lesser degree of myocardial contractility recruitment. This negative association was more evident in patients with an obstructive form at rest. BMJ Publishing Group 2012 2012-10-12 /pmc/articles/PMC3488754/ /pubmed/23065447 http://dx.doi.org/10.1136/bmjopen-2012-001267 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
spellingShingle Cardiovascular Medicine
Biagini, Elena
Lorenzini, Massimiliano
Olivotto, Iacopo
Rocchi, Guido
Lovato, Luigi
Lai, Francesco
Rosmini, Stefania
Pazzi, Chiara
Pasquale, Ferdinando
Reggiani, Maria Letizia Bacchi
Fattori, Rossella
Rapezzi, Claudio
Effects of myocardial fibrosis assessed by MRI on dynamic left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a retrospective database analysis
title Effects of myocardial fibrosis assessed by MRI on dynamic left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a retrospective database analysis
title_full Effects of myocardial fibrosis assessed by MRI on dynamic left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a retrospective database analysis
title_fullStr Effects of myocardial fibrosis assessed by MRI on dynamic left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a retrospective database analysis
title_full_unstemmed Effects of myocardial fibrosis assessed by MRI on dynamic left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a retrospective database analysis
title_short Effects of myocardial fibrosis assessed by MRI on dynamic left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a retrospective database analysis
title_sort effects of myocardial fibrosis assessed by mri on dynamic left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a retrospective database analysis
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488754/
https://www.ncbi.nlm.nih.gov/pubmed/23065447
http://dx.doi.org/10.1136/bmjopen-2012-001267
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