title: Cardiac remodelling identified by cardiovascular magnetic resonance in patients with hepatitis C infection and liver disease.
abstract: Chronic cardiac dysfunction in patients with chronic liver disease (CLD) in the absence of alcohol consumption or other cardiac disease is well described. Whilst functional and morphological features of this condition remain unclear, diastolic dysfunction has been implicated by echocardiography. We aimed to evaluate myocardial structure, function and tissue composition with cardiac magnetic resonance (CMR) imaging in patients with hepatitis C and histological evidence of liver disease on biopsy. Contrast-enhanced CMR imaging for morphological, functional and tissue characterization was performed on 16 patients with CLD and 21 healthy controls. Cardiac structure and function was assessed with standard cine imaging, with Late Gadolinium Enhancement (LGE) and myocardial T1 mapping (pre- and post-contrast) performed to evaluate regional and diffuse myocardial fibrosis respectively. Compared to controls, patients with CLD demonstrated lower left ventricular end-diastolic volume (LVEDV) (138 ± 36 vs. 167 ± 44 mL, p < 0.05), reduced stroke volume (88 ± 20 vs. 109 ± 29 mL, p = 0.016), lower post-contrast myocardial T1 time and higher Partition Coefficient consistent with diffuse myocardial fibrosis (466 ± 78 vs. 545 ± 134 ms and 0.247 ± 0.110 vs. 0.123 ± 0.057 %, p < 0.05 for both). There were no differences in other cardiac parameters including left ventricular mass and ejection fraction (p = NS for all comparisons). No patients in either group had evidence of LGE. Compared to controls, patients with hepatitis C and histological evidence liver involvement have lower LVEDV, SV and increased diffuse myocardial fibrosis, all of which are associated with diastolic dysfunction. LVEF and LV mass were preserved. This may explain in part previous functional observations made by echocardiography.
authors.affiliation: Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia.|Baker IDI Heart and Diabetes Institute, Heart Centre, Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Ngu
authors.affiliation: Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia.|Baker IDI Heart and Diabetes Institute, Heart Centre, Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Butler
authors.affiliation: Department of Anatomical Pathology, Alfred Hospital, Melbourne, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Pham
authors.affiliation: Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.
authors.forename: Stuart K
authors.initials: SK
authors.lastname: Roberts
authors.affiliation: Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia. A.taylor@alfred.org.au.|Baker IDI Heart and Diabetes Institute, Heart Centre, Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia. A.taylor@alfred.org.au.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Taylor
mesh_terms: D000328:Adult; D001706:Biopsy; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D016022:Case-Control Studies; D003287:Contrast Media; D003971:Diastole; D005260:Female; D005355:Fibrosis; D019786:Gadolinium DTPA; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000821:virology*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling; D055815:Young Adult
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Diastolic dysfunction; Hepatitis C; Liver disease; Myocardial fibrosis; T1 time