Published Online
on September 3, 2009

A more recent version of this article appeared on November 1, 2009

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Original Article

Influence of Myocardial Fibrosis on Left Ventricular Diastolic Function: Non-Invasive Assessment by CMR and ECHO

Antonella Moreo¹; Giuseppe Ambrosio²; Benedetta De Chiara³; Min Pu⁴; Tam Tran⁴; Francesco Mauri³ and Subha V. Raman^4,5

¹ Ohio State University, Columbus, OH & Niguarda Hospital, Milan, Italy;
² University of Perugia School of Medicine, Perugia, Italy;
³ Niguarda Hospital, Milan, Italy;
⁴ Ohio State University, Columbus, OH

^* Corresponding author; email: raman.1{at}osu.edu

Background—Fibrosis is a common endpoint of many pathologic processes affecting the myocardium, and may alter myocardial relaxation properties. By measuring myocardial fibrosis with CMR and diastolic function with Doppler echocardiography, we sought to define the influence of fibrosis on left ventricular (LV) diastolic function.

Methods and Results—204 eligible subjects from 252 consecutive undergoing late post-gadolinium myocardial enhancement cardiac magnetic resonance (LGE-CMR) and Doppler echocardiography were investigated. Subjects with normal diastolic function exhibited no or minimal fibrosis (median LGE score 0, IQR 0 - 0). In contrast, the majority of patients with cardiomyopathy (regardless of etiology) had abnormal diastolic function indices and substantial fibrosis (median LGE score 3, IQR 0 – 6.25). Prevalence of LGE-positivity by diastolic filling pattern was 13% in normal, 48% in impaired relaxation, 78% in pseudo-normal and 87% in restrictive filling (p<0.0001). Similarly, LGE score was significantly higher in patients with deceleration time <150ms (p<0.012), and it also progressively increased with increasing LV filling pressure estimated by TDI-derived E/E' (p<0.0001). After multivariate analysis, LGE remained significantly correlated with degree of diastolic dysfunction (p=0.0001).

Conclusion—Severity of myocardial fibrosis by LGE significantly correlates with the degree of diastolic dysfunction in a broad range of cardiac conditions. Non-invasive assessment of myocardial fibrosis may provide valuable insights into the pathophysiology of LV diastolic function and therapeutic response.

Key Words: collagen • diastole • echocardiography • magnetic resonance imaging • myocardium