Association of myocardial fibrosis and cardiovascular events: the multi-ethnic study of atherosclerosis. (16th October 2018)

• Record Type: Journal Article
• Authors: Ambale-Venkatesh, Bharath; Liu, Chia-Ying; Liu, Yuan-Chang; Donekal, Sirisha; Ohyama, Yoshiaki; Sharma, Ravi K; Wu, Colin O; Post, Wendy S; Hundley, Gregory W; Bluemke, David A; Lima, João A C
• Is Part Of: European heart journal. Volume 20:Number 2(2019)
• Page Start: 168
• Page End: 176
• Publication Date: 2018-10-16
• Subjects: myocardial fibrosis -- cardiovascular disease -- T1 mapping -- cardiac magnetic resonance imaging -- extracellular volume; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jey140
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Aims: We used contrast-enhanced cardiac magnetic resonance (CMR) to evaluate differences in myocardial fibrosis measured at the year-10 examination between participants with and without cardiovascular (CV) events accrued in a large population based study over the preceding 10-year follow-up period in this retrospective study. Methods and results: The MESA study enrolled 6814 participants free of CV disease at baseline (2000–2002). We included MESA participants who underwent contrast-enhanced CMR at the MESA year-10 exam ( N = 1840). We defined a composite CV endpoint of coronary heart disease, heart failure, atrial fibrillation, stroke, and peripheral artery disease. Using CMR, we characterized myocardial fibrosis with late-gadolinium enhancement for scar and T1 mapping indices of diffuse fibrosis. Demographic and CV-risk adjusted logistic (presence of scar) and linear regression (pre-contrast T1, T1 at 12 and 25 min post-contrast, and extracellular volume fraction or ECV) models were used to assess the relationship between fibrosis and events. The mean values of T1 indices were—pre-contrast T1: 977 ± 45 ms; T1 at 12': 456 ± 40 ms; T1 at 25': 519 ± 41 ms; ECV: 27.1 ± 3.2%. One-hundred and forty-six (7.9%) participants had myocardial scar. The presence of scar was strongly associated with prior CV events (adjusted coeff: 1.36, P < 0.001). Lower post-contrast T1 times and higher ECV, indicative of greater diffuse fibrosis were strongly associated with CV events (T1 at 12': coeff = −10.0 ms, P = 0.004; T1 at 25': coeff =−9.2 ms, P = 0.008; ECV: coeff = 1.31%, P < 0.001). Conclusion: Individuals who suffered prior CV events have greater likelihood of diffuse myocardial fibrosis when compared with event-free individuals living in the same community.