The interplay between metabolic alterations, diastolic strain rate and exercise capacity in mild heart failure with preserved ejection fraction: a cardiovascular magnetic resonance study.
Title | The interplay between metabolic alterations, diastolic strain rate and exercise capacity in mild heart failure with preserved ejection fraction: a cardiovascular magnetic resonance study. |
Publication Type | Journal Article |
Year of Publication | 2018 |
Authors | Mahmod, M., Pal N., Rayner J., Holloway C., Raman B., Dass S., Levelt E., Ariga R., Ferreira V., Banerjee R., Schneider J. E., Rodgers C., Francis J. M., Karamitsos T. D., Frenneaux M., Ashrafian H., Neubauer S., & Rider O. |
Journal | J Cardiovasc Magn Reson |
Volume | 20 |
Issue | 1 |
Pagination | 88 |
Date Published | 2018 12 24 |
ISSN | 1532-429X |
Keywords | Adenosine Triphosphate, Aged, Biomarkers, Biomechanical Phenomena, Case-Control Studies, Energy Metabolism, Exercise Test, Exercise Tolerance, Female, Heart Failure, Humans, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Myocardial Contraction, Myocardium, Oxygen Consumption, Phosphocreatine, Predictive Value of Tests, Prospective Studies, Proton Magnetic Resonance Spectroscopy, Severity of Illness Index, Triglycerides, Ventricular Function, Left |
Abstract | BACKGROUND: Heart failure (HF) is characterized by altered myocardial substrate metabolism which can lead to myocardial triglyceride accumulation (steatosis) and lipotoxicity. However its role in mild HF with preserved ejection fraction (HFpEF) is uncertain. We measured myocardial triglyceride content (MTG) in HFpEF and assessed its relationships with diastolic function and exercise capacity.METHODS: Twenty seven HFpEF (clinical features of HF, left ventricular EF >50%, evidence of mild diastolic dysfunction and evidence of exercise limitation as assessed by cardiopulmonary exercise test) and 14 controls underwent H-cardiovascular magnetic resonance spectroscopy (H-CMRS) to measure MTG (lipid/water, %), P-CMRS to measure myocardial energetics (phosphocreatine-to-adenosine triphosphate - PCr/ATP) and feature-tracking cardiovascular magnetic resonance (CMR) imaging for diastolic strain rate.RESULTS: When compared to controls, HFpEF had 2.3 fold higher in MTG (1.45 ± 0.25% vs. 0.64 ± 0.16%, p = 0.009) and reduced PCr/ATP (1.60 ± 0.09 vs. 2.00 ± 0.10, p = 0.005). HFpEF had significantly reduced diastolic strain rate and maximal oxygen consumption (VO max), which both correlated significantly with elevated MTG and reduced PCr/ATP. On multivariate analyses, MTG was independently associated with diastolic strain rate while diastolic strain rate was independently associated with VO max.CONCLUSIONS: Myocardial steatosis is pronounced in mild HFpEF, and is independently associated with impaired diastolic strain rate which is itself related to exercise capacity. Steatosis may adversely affect exercise capacity by indirect effect occurring via impairment in diastolic function. As such, myocardial triglyceride may become a potential therapeutic target to treat the increasing number of patients with HFpEF. |
DOI | 10.1186/s12968-018-0511-6 |
Alternate Journal | J Cardiovasc Magn Reson |
PubMed ID | 30580760 |
PubMed Central ID | PMC6304764 |
Grant List | 098436 / WT_ / Wellcome Trust / United Kingdom FS/11/50/29038 / BHF_ / British Heart Foundation / United Kingdom FS/16/70/32157 / BHF_ / British Heart Foundation / United Kingdom 098436/Z/12/Z/B / WT_ / Wellcome Trust / United Kingdom FS/12/32/29559 / BHF_ / British Heart Foundation / United Kingdom / WT_ / Wellcome Trust / United Kingdom |