International Journal of Cardiology 181 (2015) 102–103
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Reply to the letter “Prognostic value of late gadolinium enhancement in cardiomyopathy: Causative risk factor or surrogate marker?” Jorge Rodríguez-Capitán a,⁎,1, José Manuel García-Pinilla b,1, Isabel Ruiz-Zamora c,1, Eloy Rueda-Calle b,1, Luis Morcillo-Hidalgo b,1, Carmen Jurado-Canca d,1, Juan Robledo-Carmona b,1, Juan José Gómez-Doblas b,1, Eduardo de Teresa-Galván b,1 a
Sección de Cardiología, Unidad de Medicina Interna, Hospital de Poniente, Carretera de Almerimar s/n, 04700 El Ejido, Almería, Spain Área del Corazón, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain c Sección de Cardiología, Unidad de Medicina Interna, Fundación Hospital Calahorra, Carretera de Logroño s/n, 26500 Calahorra, La Rioja, Spain d Unidad de Cardiología, Hospital Parque San Antonio, Avenida Pintor Joaquín Sorolla n°2, 29016, Málaga, Spain b
a r t i c l e
i n f o
Article history: Received 27 November 2014 Accepted 1 December 2014 Available online 2 December 2014 Keywords: Nonischemic cardiomyopathy Late gadolinium enhancement Cardiovascular magnetic resonance Heart failure Fibrosis
A rise of left ventricular wall stress provides a deleterious cardiac remodelling. It has been shown that increased left ventricular wall stress is related to LGE in patients with NIDC [6]. In this sense, wall stress could explain part of the adverse prognostic value of LGE. Alter and Figiel suggested [1] us to assess the prognostic value of ventricular wall stress in our study [2]. We agree with the idea that this evaluation could improve the relevance of the results that we have reported, in order to clarify if LGE is a surrogate marker of ventricular wall stress. A method to calculate left ventricular wall stress using cardiac magnetic resonance has been described [7]. End-systolic and end-diastolic wall stress (σ) can be calculated from intraventricular pressure (P), and luminal (V lum) and myocardial (V myo) volumes, using the following formula: σ ¼
P
V lumþV myo 2=3 −1: V lum
We thank Peter Alter and Jens H. Figiel for their interesting letter [1] regarding our recent study about prognostic value of late gadolinium enhancement (LGE) in patients with nonischemic dilated cardiomyopathy (NIDC) [2]. The presence of LGE areas in cardiac magnetic resonance imaging studies has been related to fibrosis in patients with NIDC, and this presence has shown excellent agreement with regions of replacement fibrosis seen in explanted hearts [3]. In addition to this, it has been described that diffuse fibrosis can be detected using methods of T1 mapping [4], which were not available in our study. However, as Alter and Figiel suggested, LGE cannot be considered as a synonymous of fibrosis, because every remodelling of the interstitial space can probably lead to this enhancement [1]. Whether LGE is an independent risk factor in patients with NIDC, or whether it is an epiphenomenon of advanced cardiac remodelling associated with established prognostic factors has been argued in previous reviews [5] and still remains unclear. ⁎ Corresponding author at: Plaza Enrique Navarro 3, 1°d, 29002 Málaga, Spain. E-mail address: [email protected] (J. Rodríguez-Capitán). 1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
http://dx.doi.org/10.1016/j.ijcard.2014.12.007 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
Unfortunately, the evaluation of ventricular wall stress was not our aim when we designed our study, and we did not collect data regarding intraventricular pressure, neither did we for luminal or myocardial volumes. Currently, it is impossible for us to easily obtain all these data, so we cannot calculate ventricular wall stress. However, we have set the goal of evaluating, in future research, both the prognostic value of left ventricular wall stress assessed by cardiac magnetic resonance, and the relationship between this parameter and LGE in our patients with NIDC secondary to a wide spectrum of possible etiologies. Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] Alter Peter, H. Figiel Jens, Prognostic value of late gadolinium enhancement in cardiomyopathy: causative risk factor or surrogate marker? Int. J. Cardiol. (2014), http://dx. doi.org/10.1016/j.ijcard.2014.11.173. [2] J. Rodríguez-Capitán, J.M. García-Pinilla, I. Ruiz-Zamora, E. Rueda-Calle, L. MorcilloHidalgo, C. Jurado-Canca, et al., Long-term prognostic value of late gadolinium
J. Rodríguez-Capitán et al. / International Journal of Cardiology 181 (2015) 102–103 enhancement in a cohort of patients with nonischemic dilated cardiomyopathy, Int. J. Cardiol. 177 (2014) 17–19. [3] A. Gulati, A. Jabbour, T.F. Ismail, K. Guha, J. Khwaja, S. Raza, K. Morarji, T.D. Brown, N.A. Ismail, M.R. Dweck, E. Di Pietro, M. Roughton, R. Wage, Y. Daryani, R. O'Hanlon, M.N. Sheppard, F. Alpendurada, A.R. Lyon, S.A. Cook, M.R. Cowie, R.G. Assomull, D.J. Pennell, S.K. Prasad, Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy, JAMA 309 (2013) 896–908. [4] C.T. Sibley, R.A. Noureldin, N. Gai, M.S. Nacif, S. Liu, E.B. Turkbey, et al., T1 mapping in cardiomyopathy at cardiac MR: comparison with endomyocardial biopsy, Radiology 265 (2012) 724–732.
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[5] T.F. Ismail, S.K. Prasad, D.J. Pennell, Prognostic importance of late gadolinium enhancement cardiovascular magnetic resonance in cardiomyopathy, Heart 98 (2012) 438–442. [6] P. Alter, H. Rupp, P. Adams, F. Stoll, J.H. Figiel, K.J. Klose, et al., Occurrence of late gadolinium enhancement is associated with increased left ventricular wall stress and mass in patients with non-ischaemic dilated cardiomyopathy, Eur. J. Heart Fail. 13 (2011) 937–944. [7] P. Alter, H. Rupp, M.B. Rominger, A. Vollrath, F. Czerny, K.J. Klose, et al., Relation of Btype natriuretic peptide to left ventricular wall stress as assessed by cardiac magnetic resonance imaging in patients with dilated cardiomyopathy, Can. J. Physiol. Pharmacol. 85 (2007) 790–799.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Reply to the letter “Prognostic value of late gadolinium enhancement in cardiomyopathy: Causative risk factor or surrogate marker?” Jorge Rodríguez-Capitán a,⁎,1, José Manuel García-Pinilla b,1, Isabel Ruiz-Zamora c,1, Eloy Rueda-Calle b,1, Luis Morcillo-Hidalgo b,1, Carmen Jurado-Canca d,1, Juan Robledo-Carmona b,1, Juan José Gómez-Doblas b,1, Eduardo de Teresa-Galván b,1 a
Sección de Cardiología, Unidad de Medicina Interna, Hospital de Poniente, Carretera de Almerimar s/n, 04700 El Ejido, Almería, Spain Área del Corazón, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain c Sección de Cardiología, Unidad de Medicina Interna, Fundación Hospital Calahorra, Carretera de Logroño s/n, 26500 Calahorra, La Rioja, Spain d Unidad de Cardiología, Hospital Parque San Antonio, Avenida Pintor Joaquín Sorolla n°2, 29016, Málaga, Spain b
a r t i c l e
i n f o
Article history: Received 27 November 2014 Accepted 1 December 2014 Available online 2 December 2014 Keywords: Nonischemic cardiomyopathy Late gadolinium enhancement Cardiovascular magnetic resonance Heart failure Fibrosis
A rise of left ventricular wall stress provides a deleterious cardiac remodelling. It has been shown that increased left ventricular wall stress is related to LGE in patients with NIDC [6]. In this sense, wall stress could explain part of the adverse prognostic value of LGE. Alter and Figiel suggested [1] us to assess the prognostic value of ventricular wall stress in our study [2]. We agree with the idea that this evaluation could improve the relevance of the results that we have reported, in order to clarify if LGE is a surrogate marker of ventricular wall stress. A method to calculate left ventricular wall stress using cardiac magnetic resonance has been described [7]. End-systolic and end-diastolic wall stress (σ) can be calculated from intraventricular pressure (P), and luminal (V lum) and myocardial (V myo) volumes, using the following formula: σ ¼
P
V lumþV myo 2=3 −1: V lum
We thank Peter Alter and Jens H. Figiel for their interesting letter [1] regarding our recent study about prognostic value of late gadolinium enhancement (LGE) in patients with nonischemic dilated cardiomyopathy (NIDC) [2]. The presence of LGE areas in cardiac magnetic resonance imaging studies has been related to fibrosis in patients with NIDC, and this presence has shown excellent agreement with regions of replacement fibrosis seen in explanted hearts [3]. In addition to this, it has been described that diffuse fibrosis can be detected using methods of T1 mapping [4], which were not available in our study. However, as Alter and Figiel suggested, LGE cannot be considered as a synonymous of fibrosis, because every remodelling of the interstitial space can probably lead to this enhancement [1]. Whether LGE is an independent risk factor in patients with NIDC, or whether it is an epiphenomenon of advanced cardiac remodelling associated with established prognostic factors has been argued in previous reviews [5] and still remains unclear. ⁎ Corresponding author at: Plaza Enrique Navarro 3, 1°d, 29002 Málaga, Spain. E-mail address: [email protected] (J. Rodríguez-Capitán). 1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
http://dx.doi.org/10.1016/j.ijcard.2014.12.007 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
Unfortunately, the evaluation of ventricular wall stress was not our aim when we designed our study, and we did not collect data regarding intraventricular pressure, neither did we for luminal or myocardial volumes. Currently, it is impossible for us to easily obtain all these data, so we cannot calculate ventricular wall stress. However, we have set the goal of evaluating, in future research, both the prognostic value of left ventricular wall stress assessed by cardiac magnetic resonance, and the relationship between this parameter and LGE in our patients with NIDC secondary to a wide spectrum of possible etiologies. Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] Alter Peter, H. Figiel Jens, Prognostic value of late gadolinium enhancement in cardiomyopathy: causative risk factor or surrogate marker? Int. J. Cardiol. (2014), http://dx. doi.org/10.1016/j.ijcard.2014.11.173. [2] J. Rodríguez-Capitán, J.M. García-Pinilla, I. Ruiz-Zamora, E. Rueda-Calle, L. MorcilloHidalgo, C. Jurado-Canca, et al., Long-term prognostic value of late gadolinium
J. Rodríguez-Capitán et al. / International Journal of Cardiology 181 (2015) 102–103 enhancement in a cohort of patients with nonischemic dilated cardiomyopathy, Int. J. Cardiol. 177 (2014) 17–19. [3] A. Gulati, A. Jabbour, T.F. Ismail, K. Guha, J. Khwaja, S. Raza, K. Morarji, T.D. Brown, N.A. Ismail, M.R. Dweck, E. Di Pietro, M. Roughton, R. Wage, Y. Daryani, R. O'Hanlon, M.N. Sheppard, F. Alpendurada, A.R. Lyon, S.A. Cook, M.R. Cowie, R.G. Assomull, D.J. Pennell, S.K. Prasad, Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy, JAMA 309 (2013) 896–908. [4] C.T. Sibley, R.A. Noureldin, N. Gai, M.S. Nacif, S. Liu, E.B. Turkbey, et al., T1 mapping in cardiomyopathy at cardiac MR: comparison with endomyocardial biopsy, Radiology 265 (2012) 724–732.
103
[5] T.F. Ismail, S.K. Prasad, D.J. Pennell, Prognostic importance of late gadolinium enhancement cardiovascular magnetic resonance in cardiomyopathy, Heart 98 (2012) 438–442. [6] P. Alter, H. Rupp, P. Adams, F. Stoll, J.H. Figiel, K.J. Klose, et al., Occurrence of late gadolinium enhancement is associated with increased left ventricular wall stress and mass in patients with non-ischaemic dilated cardiomyopathy, Eur. J. Heart Fail. 13 (2011) 937–944. [7] P. Alter, H. Rupp, M.B. Rominger, A. Vollrath, F. Czerny, K.J. Klose, et al., Relation of Btype natriuretic peptide to left ventricular wall stress as assessed by cardiac magnetic resonance imaging in patients with dilated cardiomyopathy, Can. J. Physiol. Pharmacol. 85 (2007) 790–799.
