Open Access
01.12.2015 | Moderated poster presentation
Myocardial fibrosis is associated with subsequent death and hospitalization for heart failure in obese adults
verfasst von:
Yaron Fridman, Timothy C Wong, Kayla M Piehler, Karolina M Zareba, James Moon, Martin Ugander, Daniel Messroghli, John M Jakicic, Uma Valeti, Chung-Chou Chang, Sanjeev G Shroff, Christopher A Miller, Matthias Schmitt, Peter Kellman, Javed Butler, Mihai Gheorghiade, Erik B Schelbert
Cardiac imaging in obese adults poses significant technical challenges, yet the prognostic value of diffuse myocardial fibrosis in obese adults quantified with cardiovascular magnetic resonance (CMR) extracellular volume fraction (ECV) measures is unknown. This issue is important because obesity increases the risks of death and hospitalization for heart failure (HHF). Myocardial fibrosis measured in obese adults with ECV may indicate vulnerability to death and HHF.
Methods
We enrolled 480 consecutive obese patients with a BMI >30 referred for cardiovascular magnetic resonance (CMR) without amyloidosis, stress cardiomyopathy, or hypertrophic cardiomyopathy. We quantified myocardial fibrosis with CMR ECV measures in noninfarcted myocardium. Patient data, BMI, hematocrit, were collected on the day of CMR, and we tracked outcomes prospectively.
Anzeige
Results
Median BMI was 35 (IQR 32-41), and median ECV was 27.7% (IQR 25.6%-30.9%, range). BMI and ECV were not related (p=0.90). Over a median 1.5 years (IQR 0.9-2.5yrs), 27 HHF events and 28 deaths occurred after CMR in 50 individuals. Adjusting for age, gender, renal function, myocardial infarction size, ejection fraction, hospitalization status, and heart failure stage, ECV in obese adults was associated with HHF (HR1.92 95%CI 1.40-2.65 for every 5% increase in ECV (ECV range: 16.6-45.8), death (HR 2.50 95%CI 1.59-3.95) or both (HR1.97 95%CI 1.44-2.70). ECV improved the classification of obese adults at risk and improved model discrimination for the composite outcome: e.g., HHF or death [continuous net reclassification improvement (NRI) 0.429, 95%CI 0.063-0.758; p=0.02; integrated discrimination improvement (IDI) 0.069, 95% CI 0.016-0.132; p=0.02].
Conclusions
Despite the challenges of cardiac imaging in obese adults, diffuse myocardial fibrosis quantified by ECV is associated with HHF, death, or both. Myocardial fibrosis may represent a principal marker of cardiac vulnerability that improves risk stratification even in the setting of obesity. Since myocardial fibrosis can be reversible, myocardial fibrosis and the fibroblast that regulates it may be attractive therapeutic targets in obese patients.
Funding
Dr. Schelbert was supported by a grant from The Pittsburgh Foundation,Grant M2009-0068, and an American Heart Association Scientist Development grant (09SDG2180083) including a T. Franklin Williams Scholarship Award; funding provided by: Atlantic Philanthropies, Inc., the John A. Hartford Foundation, the Association of Specialty Professors, and the AHA. Dr. Wong was supported by a grant K12 HS19461-01 from the AHRQ. Dr. Shroff's research was supported by the McGinnis Endowed Chair funds. This work was also supported by Grant Number UL1 RR024153 from the National Center for Research Resources (NCRR), NIH.
Figure 1
×
Table 1
In multivariable models, EC in noninfarcted myocardium in obese patients remained associated with the combined endpoint of HHF/death. The addition of ECV improved the classification of individuals at risk (new reclassification improvement, NRI) and the discrimination of the model (integrated discrimination improvement, IDI).
Multivariable Cox regression model
Hazard Ratio for every 5% increase in ECV (95% CI; p value)
Category free NRI (95% CI; p value)
Categorical NRI 0,.05, 0.10 risk categories (95%CI); p value)
IDI (95%CI; p value)
Modeling composite of HHF or death,
stratified by heart failure stage and hospitalization status, adjusted for EF, age, glomerular filtration rate, myocardial infarction size, and gender
1.97
(1.44-2.70; p<0.001)
0.43
(0.06-0.76; p=0.02)
0.04
(0.005-0.079; p=0.02)
0.069
(0.016-0.132; p=0.02)
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
Myocardial fibrosis is associated with subsequent death and hospitalization for heart failure in obese adults
verfasst von
Yaron Fridman Timothy C Wong Kayla M Piehler Karolina M Zareba James Moon Martin Ugander Daniel Messroghli John M Jakicic Uma Valeti Chung-Chou Chang Sanjeev G Shroff Christopher A Miller Matthias Schmitt Peter Kellman Javed Butler Mihai Gheorghiade Erik B Schelbert
In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.
Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.
Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.
Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.
Update Radiologie
Bestellen Sie unseren Fach-Newsletterund bleiben Sie gut informiert.
