Abstract 17646: Echo-derived Diastolic Strain Rate is Associated With T2* in End Stage Liver Disease
Introduction: Cardiac MRI-derived T2* correlates well with myocardial iron deposition and helps identify those at risk for major cardiac complications after liver transplant (LT). Cardiac MRI may not be practical in some patients, however. Abnormal left ventricular strain rates , measured by echocardiography, has been used to identify pathology in other infiltrative cardiomyopathies and may be useful clinically in evaluating for cardiac siderosis.
Hypothesis: We hypothesized that LV systolic strain rate (SSR) and early diastolic strain rate (DSRe) would be associated with T2* in patients with end-stage liver disease (ESLD) with suspected iron overload.
Methods: We retrospectively measured SSR and DSRe in 101 patients undergoing cardiac MRI at UCSF between 2008 and 2014 as part of LT evaluation. Individuals had echocardiograms within 3 months of the MRI, and ferritin levels were >1000 or there was clinical suspicion for hemochromatosis. Multivariate linear regression with a backward stepwise elimination was performed to investigate how echocardiogram parameters were associated with T2* values.
Results: Overall the population studied (mean age 54 yrs, 68% male, 43% Caucasian) had normal systolic function (mean EF of 68 ±8%), but 42% had abnormal diastolic function. Average T2* values were 26.3 ± 9.5, with 28% having T2* values <20 and 7% having T2* values ≤ 10. In univariate analysis, SSR and global longitudinal strain (GLS) were not significantly associated with T2*, however, several markers of abnormal diastology were: the presence of diastolic dysfunction, peak E velocities, DSRe, elevated E/e’ and elevated E/DSRe. In multivariable linear regression, lower T2s* values were associated with lower BMI, lower systolic blood pressure, Asian race, and reduced EF. Of all the diastolic parameters individually added to this multivariable model, E/DSRe had the greatest added value in predicting lower T2* (likelihood ratio chi squared statistic of 7.93, p = 0.0049).
Conclusions: Abnormal diastolic parameters, especially higher E/DSRe ratio--a novel marker of diastolic function--is associated with lower T2* in ESLD and may provide an additional metric beyond EF for screening for cardiac siderosis in these patients.
Author Disclosures: J.M. Tyler: None. D.R. Anderson: None. N. Mehta: None. K. Ordovas: None. E. Foster: Other Research Support; Modest; Abbott Vascular. G. Brooks: None. A.N. Qasim: Other Research Support; Modest; Abbott Vascular.
- © 2016 by American Heart Association, Inc.