Detection of cardiac fibrosis by LGE MRI and circulating biomarkers in patients with myocardial infarction.

Cardiac adverse remodeling takes place in almost every cardiac disease. A main
determinant of the adverse remodeling is the deposition of connective tissue in
the heart: fibrosis. Fibrosis results in a reduced pump function and an
increased susceptibility to arrhythmias. Early assessment of the adverse
cardiac remodeling is of particular interest for risk stratification and
adjustment of therapy in cardiac patients.
In the clinics, contrast-based MRI is used to determine cardiac fibrosis.
Unfortunately, with this technique only larger patches of fibrosis can be
observed. Therefore, new MRI techniques are currently developed to improve the
detection of cardiac fibrosis.
In the last decade there is also increasing interest in circulating biomarkers;
molecules that reflect biological processes which are detectable in the
circulation. During fibrosis formation, specific fibrotic biomarkers are
released in the blood stream. However, there is only scarce knowledge about the
relation between these biomarkers and cardiac fibrosis. In addition to the
diagnostic tool of biomarkers, biomarkers may also have a prognostic value.
Recently, new potential biomarkers have been identified by the Experimental
Cardiology Department (UMC Utrecht) that might be related to the progression of
heart failure after a myocardial infarction.

The primary objective of this study is to investigate whether circulating
fibrotic biomarkers are related to the amount of cardiac fibrosis as determined
by MRI in patients. Secondarily, this study aims to investigate whether these
biomarkers are related to cardiac function and the prognosis of the MI
patients.
In addition, this study serves as a pilot to identify new circulating
biomarkers that are associated with fibrosis and cardiac function. Also the
predictive and prognostic value of these biomarkers is investigated.
Next to the biomarker investigation, this study is used as pilot-study to
investigate promising new MRI techniques that may be used for fibrosis
detection. These new MRI techniques are compared to the contrast-based MRI
technique.

Patients with an acute myocardial infarction are followed in time (78
patients). Blood is drawn at four time points to evaluate biomarker levels. At
three time points, the patient undergoes MRI and echocardiography to evaluate
the cardiac function and cardiac fibrosis.

Burden:
For study purposes, the subjects will come back to the UMC Utrecht twice. The
total burden for the subjects will be ± 5 hours (3 extra MRIs, one extra echo,
and blood withdrawal). The subject may experience laying down without movement
and the small space in the MRI as a burden.

Risks:
There are hardly any risks associated with study participation. All study
procedures are according to standard procedures in the UMC Utrecht and are also
used in daily practice. The possible risks are related to the MRI:
claustrophobia, kidney toxicity, and a reaction against the contrast agent.