Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction

Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction

Abstract Cardiac magnetic resonance (CMR) is emerging as an important tool in the assessment of heart failure with preserved ejection fraction (HFpEF). This study sought to investigate the prognostic value of multiparametric CMR, including left and right heart volumetric assessment, native T1-mappin...

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Autores principales: Pankaj Garg, Hosamadin Assadi, Rachel Jones, Wei Bin Chan, Peter Metherall, Richard Thomas, Rob van der Geest, Andrew J. Swift, Abdallah Al-Mohammad
Formato: article
Lenguaje:EN
Publicado: Nature Portfolio 2021
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Acceso en línea:https://doaj.org/article/a4f57e5449a64e828986f72420b202aa
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spelling oai:doaj.org-article:a4f57e5449a64e828986f72420b202aa2021-12-02T14:12:09ZLeft ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction10.1038/s41598-020-79729-62045-2322https://doaj.org/article/a4f57e5449a64e828986f72420b202aa2021-01-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-79729-6https://doaj.org/toc/2045-2322Abstract Cardiac magnetic resonance (CMR) is emerging as an important tool in the assessment of heart failure with preserved ejection fraction (HFpEF). This study sought to investigate the prognostic value of multiparametric CMR, including left and right heart volumetric assessment, native T1-mapping and LGE in HFpEF. In this retrospective study, we identified patients with HFpEF who have undergone CMR. CMR protocol included: cines, native T1-mapping and late gadolinium enhancement (LGE). The mean follow-up period was 3.2 ± 2.4 years. We identified 86 patients with HFpEF who had CMR. Of the 86 patients (85% hypertensive; 61% males; 14% cardiac amyloidosis), 27 (31%) patients died during the follow up period. From all the CMR metrics, LV mass (area under curve [AUC] 0.66, SE 0.07, 95% CI 0.54–0.76, p = 0.02), LGE fibrosis (AUC 0.59, SE 0.15, 95% CI 0.41–0.75, p = 0.03) and native T1-values (AUC 0.76, SE 0.09, 95% CI 0.58–0.88, p < 0.01) were the strongest predictors of all-cause mortality. The optimum thresholds for these were: LV mass > 133.24 g (hazard ratio [HR] 1.58, 95% CI 1.1–2.2, p < 0.01); LGE-fibrosis > 34.86% (HR 1.77, 95% CI 1.1–2.8, p = 0.01) and native T1 > 1056.42 ms (HR 2.36, 95% CI 0.9–6.4, p = 0.07). In multivariate cox regression, CMR score model comprising these three variables independently predicted mortality in HFpEF when compared to NTproBNP (HR 4 vs HR 1.65). In non-amyloid HFpEF cases, only native T1 > 1056.42 ms demonstrated higher mortality (AUC 0.833, p < 0.01). In patients with HFpEF, multiparametric CMR aids prognostication. Our results show that left ventricular fibrosis and hypertrophy quantified by CMR are associated with all-cause mortality in patients with HFpEF.Pankaj GargHosamadin AssadiRachel JonesWei Bin ChanPeter MetherallRichard ThomasRob van der GeestAndrew J. SwiftAbdallah Al-MohammadNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-11 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Pankaj Garg
Hosamadin Assadi
Rachel Jones
Wei Bin Chan
Peter Metherall
Richard Thomas
Rob van der Geest
Andrew J. Swift
Abdallah Al-Mohammad
Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction
description Abstract Cardiac magnetic resonance (CMR) is emerging as an important tool in the assessment of heart failure with preserved ejection fraction (HFpEF). This study sought to investigate the prognostic value of multiparametric CMR, including left and right heart volumetric assessment, native T1-mapping and LGE in HFpEF. In this retrospective study, we identified patients with HFpEF who have undergone CMR. CMR protocol included: cines, native T1-mapping and late gadolinium enhancement (LGE). The mean follow-up period was 3.2 ± 2.4 years. We identified 86 patients with HFpEF who had CMR. Of the 86 patients (85% hypertensive; 61% males; 14% cardiac amyloidosis), 27 (31%) patients died during the follow up period. From all the CMR metrics, LV mass (area under curve [AUC] 0.66, SE 0.07, 95% CI 0.54–0.76, p = 0.02), LGE fibrosis (AUC 0.59, SE 0.15, 95% CI 0.41–0.75, p = 0.03) and native T1-values (AUC 0.76, SE 0.09, 95% CI 0.58–0.88, p < 0.01) were the strongest predictors of all-cause mortality. The optimum thresholds for these were: LV mass > 133.24 g (hazard ratio [HR] 1.58, 95% CI 1.1–2.2, p < 0.01); LGE-fibrosis > 34.86% (HR 1.77, 95% CI 1.1–2.8, p = 0.01) and native T1 > 1056.42 ms (HR 2.36, 95% CI 0.9–6.4, p = 0.07). In multivariate cox regression, CMR score model comprising these three variables independently predicted mortality in HFpEF when compared to NTproBNP (HR 4 vs HR 1.65). In non-amyloid HFpEF cases, only native T1 > 1056.42 ms demonstrated higher mortality (AUC 0.833, p < 0.01). In patients with HFpEF, multiparametric CMR aids prognostication. Our results show that left ventricular fibrosis and hypertrophy quantified by CMR are associated with all-cause mortality in patients with HFpEF.
format article
author Pankaj Garg
Hosamadin Assadi
Rachel Jones
Wei Bin Chan
Peter Metherall
Richard Thomas
Rob van der Geest
Andrew J. Swift
Abdallah Al-Mohammad
author_facet Pankaj Garg
Hosamadin Assadi
Rachel Jones
Wei Bin Chan
Peter Metherall
Richard Thomas
Rob van der Geest
Andrew J. Swift
Abdallah Al-Mohammad
author_sort Pankaj Garg
title Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction
title_short Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction
title_full Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction
title_fullStr Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction
title_full_unstemmed Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction
title_sort left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction
publisher Nature Portfolio
publishDate 2021
url https://doaj.org/article/a4f57e5449a64e828986f72420b202aa
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