The Effect of Cardiac Fibrosis on Left Ventricular Remodeling, Diastolic Function, and N‐Terminal Pro‐B‐Type Natriuretic Peptide Levels in Patients with Nonischemic Dilated Cardiomyopathy

Background: Cardiac fibrosis is common and associated with poor prognosis in patients with heart failure. We investigated the effect of cardiac fibrosis on the left ventricular (LV) diastolic function, functional capacity, LV remodeling, and biochemical parameters in patients with nonischemic dilated cardiomyopathy (NIDC). In addition, we investigated the biochemical and echocardiographic predictors of cardiac fibrosis in this group. Methods and Results: Forty patients with NIDC were enrolled. Cardiac fibrosis was evaluated according to the presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging. Nineteen patients had cardiac fibrosis (Group I) and 21 patients did not have cardiac fibrosis (Group II). LV systolic and diastolic parameters were assessed with conventional and tissue Doppler echocardiography. N‐terminal pro‐B‐type natriuretic peptide (NT‐pro BNP) levels of each patient were recorded. Patients with cardiac fibrosis had impaired diastolic function, higher functional class and NT‐pro BNP levels, and significant LV remodeling than the patients without cardiac fibrosis. A correlation analysis revealed that the cardiac fibrosis severity was associated with functional class, cardiac chamber sizes, NT‐pro BNP levels, diastolic parameters such as E/Se. A linear regression analysis demonstrated that NT‐pro BNP and E/Se were the independent predictors of cardiac fibrosis. Conclusion: Cardiac fibrosis correlates with impaired LV diastolic function and functional capacity, elevated NT‐proBNP levels, and adverse cardiac remodeling in patients with NIDC. Therefore, the assessment of cardiac fibrosis can be useful in the management of these patients. (Echocardiography 2010;27:954‐960)

[1]  Katherine C. Wu,et al.  Late gadolinium enhancement by cardiovascular magnetic resonance heralds an adverse prognosis in nonischemic cardiomyopathy. , 2008, Journal of the American College of Cardiology.

[2]  J. Kasprzak,et al.  Enlarged Left Atrium Is a Simple and Strong Predictor of Poor Prognosis in Patients after Myocardial Infarction , 2007, Echocardiography.

[3]  A. Waggoner,et al.  Role of Tissue Doppler and Color M‐Mode Imaging for Evaluation of Diastolic Function in Ambulatory Patients with LV Systolic Dysfunction , 2007, Echocardiography.

[4]  Dudley J Pennell,et al.  Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. , 2006, Journal of the American College of Cardiology.

[5]  Peter C Austin,et al.  Outcome of heart failure with preserved ejection fraction in a population-based study. , 2006, The New England journal of medicine.

[6]  Takeshi Yamamoto,et al.  Usefulness of mitral annular velocity in predicting exercise tolerance in patients with impaired left ventricular systolic function. , 2006, The American journal of cardiology.

[7]  Douglas L Mann,et al.  Mechanisms and models in heart failure: the biomechanical model and beyond. , 2005, Circulation.

[8]  F. Ridocci,et al.  Noninvasive diagnosis of coronary artery disease in patients with heart failure and systolic dysfunction of uncertain etiology, using late gadolinium-enhanced cardiovascular magnetic resonance. , 2005, Journal of the American College of Cardiology.

[9]  Jeroen J. Bax,et al.  Head-to-head comparison between contrast-enhanced magnetic resonance imaging and dobutamine magnetic resonance imaging in men with ischemic cardiomyopathy. , 2004, The American journal of cardiology.

[10]  S. Litwin,et al.  Mechanisms of Exercise Intolerance: Insights From Tissue Doppler Imaging , 2004, Circulation.

[11]  C H Lorenz,et al.  Differentiation of Heart Failure Related to Dilated Cardiomyopathy and Coronary Artery Disease Using Gadolinium‐Enhanced Cardiovascular Magnetic Resonance , 2003, Circulation.

[12]  F. Marchlinski,et al.  Characterization of the Electroanatomic Substrate for Monomorphic Ventricular Tachycardia in Patients with Nonischemic Cardiomyopathy , 2002, Pacing and clinical electrophysiology : PACE.

[13]  Steven W. Lee,et al.  Progression of Systolic Abnormalities in Patients With “Isolated” Diastolic Heart Failure and Diastolic Dysfunction , 2002, Circulation.

[14]  M. Cerqueira,et al.  Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association , 2002, The international journal of cardiovascular imaging.

[15]  M. Cerqueira,et al.  Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. , 2002, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[16]  G. Ayers,et al.  Reversible Impairment of Left and Right Ventricular Systolic and Diastolic Function During Short‐Lasting Atrial Fibrillation in Patients with an Implantable Atrial Defibrillator: A Tissue Doppler Imaging Study , 2001, Pacing and clinical electrophysiology : PACE.

[17]  W. Schaper,et al.  Increased expression of cytoskeletal, linkage, and extracellular proteins in failing human myocardium. , 2000, Circulation research.

[18]  J. Ross,et al.  Progressive cardiac dysfunction and fibrosis in the cardiomyopathic hamster and effects of growth hormone and angiotensin-converting enzyme inhibition. , 1999, Circulation.

[19]  K. Loboz-grudzień,et al.  [Left ventricular diastolic function evaluated by Doppler echocardiography in coronary artery disease in relation to to systolic function]. , 1999, Polskie Archiwum Medycyny Wewnetrznej.

[20]  H P Schultheiss,et al.  Dilated cardiomyopathy is associated with significant changes in collagen type I/III ratio. , 1999, Circulation.

[21]  E. Tutar,et al.  Exercise performance in patients with dilated cardiomyopathy: relationship to resting left ventricular function. , 1998, International journal of cardiology.

[22]  M. Fishbein,et al.  Characteristics of wave fronts during ventricular fibrillation in human hearts with dilated cardiomyopathy: role of increased fibrosis in the generation of reentry. , 1998, Journal of the American College of Cardiology.

[23]  R A Nishimura,et al.  Determination of left ventricular filling pressure by Doppler echocardiography in patients with coronary artery disease: critical role of left ventricular systolic function. , 1997, Journal of the American College of Cardiology.

[24]  G. Sinagra,et al.  Persistence of restrictive left ventricular filling pattern in dilated cardiomyopathy: an ominous prognostic sign. , 1997, Journal of the American College of Cardiology.

[25]  A J Tajik,et al.  Noninvasive doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. , 1996, Journal of the American College of Cardiology.

[26]  A. Giordano,et al.  Independent and incremental prognostic value of Doppler-derived mitral deceleration time of early filling in both symptomatic and asymptomatic patients with left ventricular dysfunction. , 1996, Journal of the American College of Cardiology.

[27]  A. Demaria,et al.  Relation of Doppler transmitral flow patterns to functional status in congestive heart failure. , 1996, American heart journal.

[28]  A. Tenenbaum,et al.  Shortened Doppler-derived mitral A wave deceleration time: an important predictor of elevated left ventricular filling pressure. , 1996, Journal of the American College of Cardiology.

[29]  M. Enriquez-Sarano,et al.  Effective mitral regurgitant orifice area: clinical use and pitfalls of the proximal isovelocity surface area method. , 1995, Journal of the American College of Cardiology.

[30]  H. Figulla,et al.  Prognostic value of Doppler echocardiographic assessment of left ventricular filling in idiopathic dilated cardiomyopathy. , 1994, The American journal of cardiology.

[31]  Restrictive Left Ventricular Filling Pattern in Dilated Cardiomyopathy Assessed by Doppler Echocardiography: Clinical, Echocardiographic and Hemodynamic Correlations and Prognostic Implications , 1994 .

[32]  N. Reichek,et al.  Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. , 1989, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[33]  A. Tajik,et al.  Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part II. Clinical studies. , 1989, Mayo Clinic proceedings.

[34]  B. McManus,et al.  Idiopathic dilated cardiomyopathy: analysis of 152 necropsy patients. , 1987, The American journal of cardiology.

[35]  Y. Hirota,et al.  Functional and histopathologic correlation in patients with dilated cardiomyopathy: an integrated evaluation by multivariate analysis. , 1987, Journal of the American College of Cardiology.

[36]  A. DeMaria,et al.  Recommendations Regarding Quantitation in M-Mode Echocardiography: Results of a Survey of Echocardiographic Measurements , 1978, Circulation.

[37]  A. Tajik,et al.  Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part I. Physiologic and pathophysiologic features. , 1989, Mayo Clinic proceedings.