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  • Ovid Technologies (Wolters Kluwer Health)  (2)
  • Nagel, Eike  (2)
Materialart
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  • Ovid Technologies (Wolters Kluwer Health)  (2)
Sprache
Erscheinungszeitraum
  • 1
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 64, No. 4 ( 2014-10), p. 762-768
    Kurzfassung: Increased aortic stiffness is related to increased ventricular stiffness and remodeling. Myocardial fibrosis is the pathophysiological hallmark of failing heart. We investigated the relationship between noninvasive imaging markers of myocardial fibrosis, native T1, and late gadolinium enhancement, respectively, and aortic stiffness in ventricular remodeling. Consecutive patients with known dilated cardiomyopathy (n=173) underwent assessment of cardiac volumes and function, T1 mapping, scar imaging, and pulse wave velocity, a measure of aortic stiffness. Asymptomatic healthy volunteers served as controls (n=47). Controls and patients showed an increase in pulse wave velocity with age, which was accelerated in the presence of cardiovascular disease. On the contrary, native T1 increased with age in patients, but not in controls. Pulse wave velocity was associated with native T1 in the presence of disease, but not in health. Native T1 showed a strong relationship with markers of structural and functional left ventricular remodeling and diastolic impairment. Ischemic and nonischemic pathophysiology of ventricular remodeling showed a similar slope of relationship between pulse wave velocity and native T1. However, in nonischemic patients, increase in pulse wave velocity was associated with greater increase in native T1. Aortic stiffness is related to age, and this process is accelerated in the presence of disease. On the contrary, increase in interstitial myocardial fibrosis is associated with age in the presence of disease. Patients with ischemic and nonischemic dilated cardiomyopathy have a similar relationship between native T1 and pulse wave velocity, which is stronger in the latter group.
    Materialart: Online-Ressource
    ISSN: 0194-911X , 1524-4563
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2014
    ZDB Id: 2094210-2
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Kurzfassung: Introduction: Nonischemic cardiomyopathy (NICM) is a recognised cause of poor clinical outcome. NICM is characterised by intrinsic myocardial impairment, which is driven by interstitial myocardial fibrosis in a considerable majority of NICM. The lack of accurate and noninvasive characterisation of interstitial myocardial fibrosis limits recognition of disease and effective clinical management in NICM. Hypothesis: T1 mapping by CMR is a novel non-invasive imaging application with a recognized potential to significantly improve the management of patients with NICM, supporting characterization of interstitial myocardial disease, assessment of severity of disease, risk stratification as well as development of targeted therapies. Comparative prognostic relevance of T1-mapping parameters in subjects with NICM for adverse outcome is unknown. Methods: an investigator-led multicenter observational longitudinal study in patients with NICM. We standardized imaging acquisition based on the modified Look-Locker sequence (MOLLI) (3(3)3(3)5) and post-processing approach of T1 mapping, and transferred the methodology to several other centres. We determined reference ranges for T1 mapping values and provided proof of concept studies in NICM in discrimination between health and disease. The primary endpoint was all-cause mortality. Results: 805 consecutive patients (mean age (years) 50±16; males: n=499, 62%) with NICM underwent contrast-enhanced CMR with T1-mapping. During a median follow-up period of 17 months (range 36 months), we observed a total of 26 deaths (18 cardiac). Native T1, ECV and extent of LGE were strongly associated with an increased likelihood of all-cause mortality (p 〈 0.001). In multivariate analyses, native T1 was the sole independent predictor of all-cause and cardiac mortality, over and above ECV and LGE. Native T1 was also superior in correctly classifying subjects and adverse events over a 17-months period. Conclusions. In patients with NICM, non-invasive measures of interstitial myocardial fibrosis are useful in prediction of outcome. Native T1 is an independent predictor over and above conventional markers of risk, providing a basis for a novel algorithm of risk stratification in NICM.
    Materialart: Online-Ressource
    ISSN: 0009-7322 , 1524-4539
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2015
    ZDB Id: 1466401-X
    Standort Signatur Einschränkungen Verfügbarkeit
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