Impact of Myocardial Fibrosis on Cardiovascular Structure, Function and Functional Status in Heart Failure with Preserved Ejection Fraction

Lewis, Gavin A, Rosala-Hallas, Anna ORCID: 0000-0001-8012-9995, Dodd, Susanna ORCID: 0000-0003-2851-3337, Schelbert, Erik B, Williams, Simon G, Cunnington, Colin, McDonagh, Theresa and Miller, Christopher A (2022) Impact of Myocardial Fibrosis on Cardiovascular Structure, Function and Functional Status in Heart Failure with Preserved Ejection Fraction. JOURNAL OF CARDIOVASCULAR TRANSLATIONAL RESEARCH, 15 (6). pp. 1436-1443.

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Official URL: http://dx.doi.org/10.1007/s12265-022-10264-7

Abstract

Myocardial fibrosis, measured using cardiovascular magnetic resonance extracellular volume (ECV), is associated with adverse outcome in heart failure with preserved ejection fraction, but the mechanisms by which myocardial fibrosis exerts this deleterious effect are unclear. We performed mediation analyses of data from the Pirfenidone in Patients with Heart Failure and Preserved Left Ventricular Ejection Fraction (PIROUETTE) trial to determine whether myocardial fibrotic regression causes changes in cardiovascular function and functional status following antifibrotic therapy. Regression of myocardial fibrosis correlated with improvements in 6-min walk test and KCCQ clinical summary score. The only outcome variable that demonstrated a treatment effect was an increase in left ventricular ejection fraction (LVEF). The estimated average causal mediation effects of myocardial ECV, absolute myocardial extracellular matrix volume and absolute myocardial cellular volume on LVEF were 6.1%, 21.5% and 13.7%, respectively, none of which was significant and therefore not mediated by myocardial fibrosis. (PIROUETTE; NCT02932566).

Item Type:	Article
Uncontrolled Keywords:	Heart failure with preserved ejection fraction, Myocardial fibrosis, Magnetic resonance imaging (MRI), Mediation analysis
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Clinical Directorate Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	27 Jul 2022 11:01
Last Modified:	18 Jan 2023 20:54
DOI:	10.1007/s12265-022-10264-7
Open Access URL:	https://doi.org/10.1007/s12265-022-10264-7
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3159662