Document Detail

Association between extracellular matrix expansion quantified by cardiovascular magnetic resonance and short-term mortality.
MedLine Citation:
PMID:  22851543     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Extracellular matrix expansion may be a fundamental feature of adverse myocardial remodeling, it appears to be treatable, and its measurement may improve risk stratification. Yet, the relationship between mortality and extracellular matrix is not clear because of difficulties with its measurement. To assess its relationship with outcomes, we used novel, validated cardiovascular magnetic resonance techniques to quantify the full spectrum of extracellular matrix expansion not readily detectable by conventional cardiovascular magnetic resonance.
METHODS AND RESULTS: We recruited 793 consecutive patients at the time of cardiovascular magnetic resonance without amyloidosis or hypertrophic cardiomyopathy as well as 9 healthy volunteers (ages 20-50 years). We measured the extracellular volume fraction (ECV) to quantify the extracellular matrix expansion in myocardium without myocardial infarction. ECV uses gadolinium contrast as an extracellular space marker based on T1 measures of blood and myocardium pre- and post-gadolinium contrast and hematocrit measurement. In volunteers, ECV ranged from 21.7% to 26.2%, but in patients it ranged from 21.0% to 45.8%, indicating considerable burden. There were 39 deaths over a median follow-up of 0.8 years (interquartile range 0.5-1.2 years), and 43 individuals who experienced the composite end point of death/cardiac transplant/left ventricular assist device implantation. In Cox regression models, ECV related to all-cause mortality and the composite end point (hazard ratio, 1.55; 95% confidence interval, 1.27-1.88 and hazard ratio, 1.48; 95% confidence interval, 1.23-1.78, respectively, for every 3% increase in ECV), adjusting for age, left ventricular ejection fraction, and myocardial infarction size.
CONCLUSIONS: ECV measures of extracellular matrix expansion may predict mortality as well as other composite end points (death/cardiac transplant/left ventricular assist device implantation).
Timothy C Wong; Kayla Piehler; Christopher G Meier; Stephen M Testa; Amanda M Klock; Ali A Aneizi; Jonathan Shakesprere; Peter Kellman; Sanjeev G Shroff; David S Schwartzman; Suresh R Mulukutla; Marc A Simon; Erik B Schelbert
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2012-07-31
Journal Detail:
Title:  Circulation     Volume:  126     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-05     Completed Date:  2012-11-20     Revised Date:  2013-09-09    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1206-16     Citation Subset:  AIM; IM    
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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MeSH Terms
Cardiac Imaging Techniques / methods*
Extracellular Matrix / pathology*
Fibrosis / pathology
Gadolinium / diagnostic use
Heart Diseases / mortality*,  pathology*,  surgery
Magnetic Resonance Imaging / methods*
Middle Aged
Models, Cardiovascular
Myocardium / pathology
Predictive Value of Tests
Proportional Hazards Models
Risk Factors
Ventricular Remodeling / physiology*
Young Adult
Grant Support
Reg. No./Substance:
Comment In:
Circulation. 2012 Sep 4;126(10):1179-81   [PMID:  22949538 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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