Publication Date:
2014-09-10
Description:
Non-invasive imaging techniques are highly desirable as an alternative to conventional biopsy for the characterization of the remodeling of tissues associated with disease progression, including end-stage heart failure. Cardiac diffusion tensor imaging (DTI) has become an established method for the characterization of myocardial microstructure. However, the relationships between diffuse myocardial fibrosis, which is a key biomarker for staging and treatment planning of the failing heart, and measured DTI parameters have yet to be investigated systematically. In this study, DTI was performed on left ventricular specimens collected from patients with chronic end-stage heart failure as a result of idiopathic dilated cardiomyopathy ( n = 14) and from normal donors ( n = 5). Scalar DTI parameters, including fractional anisotropy (FA) and mean (MD), primary ( D 1 ), secondary ( D 2 ) and tertiary ( D 3 ) diffusivities, were correlated with collagen content measured by digital microscopy. Compared with hearts from normal subjects, the FA in failing hearts decreased by 22%, whereas the MD, D 2 and D 3 increased by 12%, 14% and 24%, respectively ( P 〈 0.01). No significant change was detected for D 1 between the two groups. Furthermore, significant correlation was observed between the DTI scalar indices and quantitative histological measurements of collagen (i.e. fibrosis). Pearson's correlation coefficients ( r ) between collagen content and FA, MD, D 2 and D 3 were –0.51, 0.59, 0.56 and 0.62 ( P 〈 0.05), respectively. The correlation between D 1 and collagen content was not significant ( r = 0.46, P = 0.05). Computational modeling analysis indicated that the behaviors of the DTI parameters as a function of the degree of fibrosis were well explained by compartmental exchange between myocardial and collagenous tissues. Combined, these findings suggest that scalar DTI parameters can be used as metrics for the non-invasive assessment of diffuse fibrosis in failing hearts. Copyright © 2014 John Wiley & Sons, Ltd. Myocardial diffuse fibrosis has been linked to arrhythmias and sudden cardiac death. Although diffusion tensor imaging (DTI) is increasingly being used to characterize cardiac diseases, quantitative correlation between DTI scalar metrics and diffuse fibrosis remains lacking. In this study, DTI parameters obtained on heart specimens from patients with idiopathic dilated cardiomyopathy and from normal donors were correlated with histological collagen content measurements. The results indicated that diffuse fibrosis is significantly correlated with water diffusivity and inversely correlated with diffusion anisotropy. Computational analysis showed that the behaviors of the DTI parameters are well explained by compartmental exchange between myocardial and collagenous tissues.
Print ISSN:
0952-3480
Electronic ISSN:
1099-1492
Topics:
Medicine
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