The interplay between metabolic alterations, diastolic strain rate and exercise capacity in mild heart failure with preserved ejection fraction: a cardiovascular magnetic resonance study
<strong>Background</strong> 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 m...
| Main Authors: | , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
BioMed Central
2018
|
| _version_ | 1797053435986575360 |
|---|---|
| author | Mahmod, M Pal, N Rayner, J Holloway, C Raman, B Dass, S Levelt, E Ariga, R Ferreira, V Banerjee, R Schneider, J Rodgers, C Francis, J Karamitsos, T Frenneaux, M Ashrafian, H Neubauer, S Rider, O |
| author_facet | Mahmod, M Pal, N Rayner, J Holloway, C Raman, B Dass, S Levelt, E Ariga, R Ferreira, V Banerjee, R Schneider, J Rodgers, C Francis, J Karamitsos, T Frenneaux, M Ashrafian, H Neubauer, S Rider, O |
| author_sort | Mahmod, M |
| collection | OXFORD |
| description | <strong>Background</strong> 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. <strong>Methods</strong> 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. <strong>Results</strong> 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. <strong>Conclusions</strong> 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. |
| first_indexed | 2024-03-06T18:43:42Z |
| format | Journal article |
| id | oxford-uuid:0dc75c07-6b07-49be-b54d-c99bcb6ee198 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T18:43:42Z |
| publishDate | 2018 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:0dc75c07-6b07-49be-b54d-c99bcb6ee1982022-03-26T09:42:19ZThe interplay between metabolic alterations, diastolic strain rate and exercise capacity in mild heart failure with preserved ejection fraction: a cardiovascular magnetic resonance studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:0dc75c07-6b07-49be-b54d-c99bcb6ee198EnglishSymplectic Elements at OxfordBioMed Central2018Mahmod, MPal, NRayner, JHolloway, CRaman, BDass, SLevelt, EAriga, RFerreira, VBanerjee, RSchneider, JRodgers, CFrancis, JKaramitsos, TFrenneaux, MAshrafian, HNeubauer, SRider, O<strong>Background</strong> 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. <strong>Methods</strong> 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. <strong>Results</strong> 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. <strong>Conclusions</strong> 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. |
| spellingShingle | Mahmod, M Pal, N Rayner, J Holloway, C Raman, B Dass, S Levelt, E Ariga, R Ferreira, V Banerjee, R Schneider, J Rodgers, C Francis, J Karamitsos, T Frenneaux, M Ashrafian, H Neubauer, S Rider, O 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 |
| title_full | 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_fullStr | 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_full_unstemmed | 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_short | 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_sort | interplay between metabolic alterations diastolic strain rate and exercise capacity in mild heart failure with preserved ejection fraction a cardiovascular magnetic resonance study |
| work_keys_str_mv | AT mahmodm theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT paln theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT raynerj theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT hollowayc theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT ramanb theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT dasss theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT levelte theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT arigar theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT ferreirav theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT banerjeer theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT schneiderj theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT rodgersc theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT francisj theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT karamitsost theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT frenneauxm theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT ashrafianh theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT neubauers theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT ridero theinterplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT mahmodm interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT paln interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT raynerj interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT hollowayc interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT ramanb interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT dasss interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT levelte interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT arigar interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT ferreirav interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT banerjeer interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT schneiderj interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT rodgersc interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT francisj interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT karamitsost interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT frenneauxm interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT ashrafianh interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT neubauers interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy AT ridero interplaybetweenmetabolicalterationsdiastolicstrainrateandexercisecapacityinmildheartfailurewithpreservedejectionfractionacardiovascularmagneticresonancestudy |