Abstract 10885: Age Independent Myocardial Fibrosis in Heart Failure With Preserved Ejection Fraction
Background: The prevalence of heart failure (HF) with preserved ejection fraction (HFpEF) increases dramatically with age. Studies conflict as to whether myocardial fibrosis increases with age in persons without HF and while fibrosis is postulated to play a key role in HFpEF pathophysiology, few studies have assessed fibrosis in HFpEF hearts. We hypothesized that myocardial fibrosis increases with age in persons without HF but that patients with HFpEF have more fibrosis than non-HF hearts independent of age.
Methods: HFpEF subjects were identified using Mayo Clinic HF databases and crossed to the Mayo Clinic Autopsy Tissue Registry (EF > 40% at HF diagnosis; n=110; age range 40-103 at death). Controls were those ≥40 years of age at death without ante-mortem HF diagnosis who died of non-cardiovascular causes and had undergone cardiac autopsy (≥ 20 pts per age at death decade ≥ 4th decade; n=130 total). Fibrosis was quantified on whole field digital microscopy of full thickness LV sections using a custom designed, stain specific quantitative analysis system consisting of a combination of intensity histogram-based and homogeneity measurements (Definiens®).
Results: See figure. In subjects without HF, myocardial fibrosis increased with age (p=0.015). Adjusting for age, myocardial fibrosis was higher in HFpEF than non-HF hearts (age adjusted p<0.0001).
Conclusion: Myocardial fibrosis increases with age in persons without HF suggesting that the aging process is associated with fibrotic LV remodeling. However, adjusting for age, HFpEF patients have more fibrosis suggesting that accelerated fibrotic remodeling may contribute to HFpEF pathophysiology and represent an important therapeutic target.
- © 2012 by American Heart Association, Inc.