The interplay between metabolic alterations, diastolic strain rate and exercise capacity in mild heart failure with preserved ejection fraction:a cardiovascular magnetic resonance study

Mahmod, Masliza, Pal, Nikhil, Rayner, Jennifer, Holloway, Cameron, Raman, Betty, Dass, Sairia, Levelt, Eylem, Ariga, Rina, Ferreira, Vanessa, Banerjee, Rajarshi, Schneider, Jurgen E, Rodgers, Christopher, Francis, Jane M, Karamitsos, Theodoros D, Frenneaux, Michael, Ashrafian, Houman, Neubauer, Stefan and Rider, Oliver (2018) The interplay between metabolic alterations, diastolic strain rate and exercise capacity in mild heart failure with preserved ejection fraction:a cardiovascular magnetic resonance study. Journal of Cardiovascular Magnetic Resonance, 20 (1). ISSN 1097-6647

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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 1H-cardiovascular magnetic resonance spectroscopy (1H-CMRS) to measure MTG (lipid/water, %), 31P-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 (VO2 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 VO2 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.

Item Type:	Article
Uncontrolled Keywords:	cardiovascular magnetic resonance,diastolic strain rate,heart failure,maximal oxygen consumption,spectroscopy,steatosis
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health
Depositing User:	LivePure Connector
Date Deposited:	23 Jan 2019 11:30
Last Modified:	12 May 2023 19:31
URI:	https://ueaeprints.uea.ac.uk/id/eprint/69658
DOI:	10.1186/s12968-018-0511-6

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