Role of cardiovascular magnetic resonance imaging and tissue characterisation in cardiac reverse remodelling

Abstract

Cardiovascular Magnetic Resonance (CMR) imaging is recognised as the gold standard for functional cardiac assessment. Tissue characterisation assessment of myocardial diffuse fibrosis with T1 mapping and estimation of Extracellular Volume (ECV) is increasingly recognised for its role in clinical diagnosis and holds potential as a non-invasive biomarker for risk stratification, predicting prognosis, or monitoring response to therapy.

Over the last decade, the landscape of Heart Failure with reduced Ejection Fraction (HFrEF) medical therapy has changed significantly with the introduction of ARNI and SGLT2 inhibitors. In this thesis, I describe the marked beneficial Left Ventricular (LV) and left atrial reverse remodelling effects, as well as changes in tissue characteristics after optimisation to contemporary HFrEF therapy, evaluated with CMR for the first time. There were significant reductions in both native and post-contrast septal and global T1 values across time. There was no reduction in ECV but instead, reductions in both absolute LV cell and matrix volumes, and LV mass were found. In this cohort, reductions in LV volumes resulted in an increase in median LVEF by 12 points. 59% no longer met criteria for complex device implantation after 6 months.

I also describe the association between baseline CMR tissue characteristics with prognosis and cardiac reverse remodelling, in two discrete Heart Failure cohorts. PREDICT-HF included patients hospitalised with a new Heart Failure diagnosis, initiated on therapy and followed up over 24 months. Higher septal native T1 values were found to be significantly associated with adverse outcome in this cohort. The ENVI study included patients with symptomatic severe LVEF <35% despite 3 months of conventional therapy, optimised to contemporary HFrEF therapy. Those who experienced beneficial reverse remodelling to an LVEF >35% after 6 months were found to have lower septal native T1 values, lower absolute LV matrix and cell volumes, and LV mass at baseline.

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Identifiers

ORCID for Alice Wen Zheng: orcid.org/0000-0003-1902-4849

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