Echocardiographic correlates of cardiac fibrosis in patients with myocardial infarction and preserved left ventricular ejection fraction

Aim. To identify the possibilities of echocardiography in the evaluation of myocardial fibrosis inт patients with ST segment elevation myocardial infarction (STEMI).

Materials and Methods. We recruited 70 consecutive patients who have undergone percutaneous coronary intervention due to STEMI. Echocardiography was performed at the time of admission, on 8th-10th day post-admission and one year after STEMI to evaluate left ventricular ejection fraction. Assessment of cardiac fibrosis was carried out at the latter time point using magnetic resonance imaging.

Results. All patients had the signs of cardiac fibrosis, yet they were more pronounced in those with decreased LVEF (40-49%). A positive correlation was observed between the extent of cardiac fibrosis and LV dimensions at the admission (p = 0.01) while the correlation of cardiac fibrosis with LVEF was negative (r = -0.30, p=0.01) at all the time points. Cardiac fibrosis was associated both with systolic and diastolic dysfunction.

Conclusion. Echocardiographic evaluation of LVEF can be useful in making diagnosis and evaluating severity of cardiac fibrosis in patients with STEMI.

1. Wynn ТА, Vanilla KM. Macrophages in tissue repair regeneration and fibrosis. Immunity. 2016; 44 (3): 450462. doi: 10.1016/j.immuni.2016.02.015.

2. Karetnikova VN, Kashtalap VV, Kosareva SN, Barbarash OL. Myocardial fibrosis: current aspects of the problem. Therapeutic Archive. 2017; 89 (1): 88-93. Russian doi: 10.17116/terarkh201789188-93).

3. The top 10 causes of death: WHO Fact Sheet N 310. Updated January 2017. Available at: http://www.who.int/mediacentre/factsheets/fs310/en/index.html (accessed: 25.08.2018).

4. Healthcare in Russia 2015: statistical compilation. Moscow, 2015. 174 p. Russian

5. Friedman SL, Sheppard D, Duffield JS, Violette S. Therapy for fibrotic diseases: nearing the starting line. Sci Transl Med. 2013; 5 (167): 167. doi: 10.1126/scitranslmed.3004700.

6. Creemers EE, van RooijE. Function and Therapeutic Potential of Noncoding RNAs in Cardiac Fibrosis. Circ Res. 2016; 118 (1): 108-118. doi: 10.1161/CIRCRESAHA.115.305242.

7. Lopez B, Gonzalez A, Ravassa S, Beaumont J, Moreno MU, San Jose G, et al. Circulating biomarkers of myocardial fibrosis: the need for a reappraisal. J Am Coll Cardiol. 2015; 65 (22): 2449-2456. doi: 10.1016/j.jacc.2015.04.026.

8. Mitkovskaya NP, Nizhnikova OG, Statkovich TV, Pateyuk IV, Balysh EM, Pinchuk AF. Pathogenic aspects of cardiac remodelling due to miocardial infarction. Medical Journal. 2013; 1 (43): 12-18. Russian

9. Dutta D, Calvani R, Bernabei R, Leeuwenburgh C, Marzetti E. Contribution of impaired mitochondrial autophagy to cardiac aging: mechanisms and therapeutic opportunities. Circ Res. 2012; 110 (8): 1125-1138. doi: 10.1161/CIRCRESAHA.111.246108.

10. Kopitsa NP, Belaya N1, Titarenko NV. Methods of diagnostics of myocardial fibrosis in hypertensive patients. Arterial Hypertension. 2008; 2 (2): 39-42. Russian

11. Ciulla MM, Paliotti R, Esposito A, Cuspidi C, Muiesan ML, Rosei EA, et al. Effects of antihypertensive treatment on ultrasound measures of myocardial fibrosis in hypertensive patients with left ventricular hypertrophy: results of a randomized trial comparing the angiotensin receptor antagonist, candesartan and the angiotensin-converting enzyme inhibitor, enalapril. J Hypertens. 2009; 27 (3): 626-632. doi: 10.1097/HJH.0b013e3283232838.

12. Treibel ТА, White SK, Moon JC. Myocardial tissue characterization: histological and pathophysiological correlation. Curr Cardiovasc Imaging Rep. 2014; 7 (3): 9254. doi: 10.1007/sl2410-013-9254-9.

13. Ruda MJ, Averkov OV, Golitsyn SP, Graciansky NA, Komarov AL, Panchenko EP, et al. Diagnosis and management of ST-segment elevation myocardial infarction: clinical guidelines. Bulletin of Cardiology. 2014; 9 (4): 3-60. Russian

14. Grant A, Negishi K, Negishi T, Collier P, Kapadia SR, Thomas JD, et al. Grading diastolic function by echocardiography: hemodynamic validation of existing guidelines. Cardiovasc Ultrasound. 2015; 13: 28. doi: 10.1186/sl2947-015-0023-6.

15. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29 (4): 277-314. doi: 10.1016/j.echo.2016.01.011.

16. Segment CMR. Medviso. Available at: http://medviso.com/products/cmr (accessed 16.04.2019).

17. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Russian Journal of Cardiology. 2017; 22 (1): 7-81. Russian doi: 10.15829/1560-4071-2017-1-7-81.

18. Ciulla M, Paliotti R, Hess DB, Tjahja E, Campbell SE, Magrini F, et al. Echocardiographic patterns of myocardial fibrosis in hypertensive patients: endomyocardial biopsy versus ultrasonic tissue characterization. J Am Soc Echocardiogr. 1997; 10 (6): 657-664. doi: 10.1016/S0894-7317(97)70028-2.

19. Kobalava ZhD, Kotovskaya YuV, Safarova AF, Moiseev VS. Echocardiographic assessment of myocardial fibrosis in young men with arterial hypertension and different types of left ventricular remodeling. Cardiology. 2011; 5 (2): 3439. Russian

20. Zakirov AN, Oganov RG, Zakirova NE, Klochkova GR, Musina FS. Myocardial remodeling in ischemic heart disease. Rational Pharmacotherapy in Cardiology. 2009; 5 (1): 42-45. Russian

21. Garganeeva AA, Borel KN, Okrugin SA, Kuzheleva EA. Effect of left ventricular ejection fraction on remote prognosis of patients after a cardiac catastrophe. Analysis of 5-year monitoring performed as a part of the population-based program “Registry of acute myocardial infarction”. Heart Failure Journal. 2014; 85 (4): 218-223. Russian

22. Dulai R, Sheikh AS, Qureshi A, Katechia S, Peysakhova Y, Johns M, et al. Prevalence, clinical characteristics and outcomes of HF with preserved versus reduced ejection fraction. Br J Cardiol. 2016; 23 (1). doi: 10.5837/bjc.2016.005.

23. Kitzman DW, Little WC. Left ventricle diastolic dysfunction and prognosis. Circulation. 2012; 125 (6): 743-745. doi: 10.1161/CIRCULATIONAHA.111.086843.

24. Kass DA, Bronzwaer JG, Paulus WJ. What mechanisms underlie diastolic dysfunction in heart failure? Circ Res. 2004; 94 (12): 1533-1542. doi: 10.1161/01.RES.0000129254.25507.d6

25. Burlew BS, Weber KT. Cardiac fibrosis as a cause of diastolic dysfunction. Herz. 2002; 27 (2): 92-98.

26. Moreo A, Ambrosio G, De Chiara B, Pu M, Tran T, Mauri F, et al. Influence of myocardial fibrosis on left ventricular diastolic function: non-invasive assessment by cardiac magnetic resonance and echo. Circ Cardiovasc Imaging. 2009; 2 (6): 437-443. doi: 10.1161/CIRCIMAGING.108.838367.

27. Kosmala W, Przewlocka-Kosmala M, Wojnalowicz A, Mysiak A, Marwick TH. Integrated backscatter as a fibrosis marker in the metabolic syndrome: association with biochemical evidence of fibrosis and left ventricular dysfunction. Eur Heart J Cardiovasc Imaging. 2012; 13 (6): 459-467. doi: 10.1093/ejechocard/jer291.

28. Kokov AN, Masenko VL, Semenov SE, Barbarash OL. Cardiac MRI in evaluation postinfarction changes and its role in determining the revascularization tactics. Complex Issues of Cardiovascular Diseases. 2014; (3): 97-102. Russian doi: 10.17802/2306-1278-2014-3-97-102.

29. Sinitsyn VE, Mershina EA, Larina OM. Cardiac magnetic resonance imaging opportunities in the diagnosis of cardiomyopathy. Clinical and Experimental Surgery. 2014; 1 (3): 54-63. Russian

30. Stukalova OV, Aparina OP, Mironova NA, Golitsyn SP. Left atrial fibrosis in patients with atrial fibrillation according to magnetic resonance imaging with late gadolinium enhancement. Almanac of Clinical Medicine. 2015; (43): 29-37. Russian

31. Amano Y, Takayama M, Takahama K, Kumazaki T. Delayed hyper-enhancement of myocardium in hypertrophic cardiomyopathy with asymmetrical septal hypertrophy: comparison with global and regional cardiac MR imaging appearances. J Magn Reson Imaging. 2004; 20 (4): 595-600. doi: 10.1002/jmri.20172.

32. Romero J, Xue X, Gonzalez W, Garcia MJ. CMR imaging assessing viability in patients with chronic ventricular dysfunction due to coronary artery disease: a meta-analysis of prospective trials. JACC Cardiovascular Imaging. 2012; 5: 494-508. doi: 10.1016/j.jcmg.2012.02.009.

33. Kukharchik GA, Pavlova AM, Mitrofanov NA. Potentials of cardiovascular magnetic resonance imaging in myocardial infarction. Bulletin of St. Petersburg University. Medicine. 2012; (2): 73-81. Russian

34. Sakovich RA. Multislice computed tomography in cardiology practice. Medical and Biological Problems of Life. 2013; 1 (9): 148-156. Russian

35. Karim R, Housden RJ, Balasubramaniam M, Chen Z, Perry D, Uddin A et al. Evaluation of current algorithms for segmentation of scar tissue from late gadolinium enhancement cardiovascular magnetic resonance of the left atrium: an open-access grand challenge. J Cardiovasc Magn Reson. 2013; 15: 105. doi: 10.1186/1532-429X-15-105.

36. Khadzegova AB, Yuschuk EN, Sinicina IA, Shupenina Eyu, Khuchinaeva AM, Nadina EV. The new capabilities in assessment of the heart functional state in arterial hypertension. Journal Sono Ace-Ultrasound. 2012; (24): 46-51. Russian