Going beyond ejection fraction - CMR assessment of ventricular-vascular coupling and LV remodeling predicts diastolic dysfunction in advanced ischemic cardiomyopathy

Background Increased ventricular and arterial stiffness is associated with diastolic dysfunction (DDFx) in patients with heart failure and preserved systolic function. Limited information is available regarding the impact of aortic biomechanics and the ventricular-vascular coupling (VVC) on DDFx in those patients with advanced ischemic cardiomyopathy (ICM). In addition, it is not known if cardiac magnetic resonance (CMR) measurements of LV remodeling (sphericity and scar burden) can also contribute to prediction of DDFx in these patients. We sought to examine the relationship between aortic biomechanical properties (ascending and descending distensibility, arch pulse wave velocity), ventricular-ventricular coupling (defined as the ratio between LV end-systolic elastance and effective arterial elastance), LV remodeling assessed by CMR and diastolic function assessed by echocardiography in patients with advanced ICM.