Associations and prognostic significance of diffuse myocardial fibrosis by cardiovascular magnetic resonance in heart failure with preserved ejection fraction

Background Increased myocardial fibrosis may play a key role in heart failure with preserved ejection fraction (HFpEF) pathophysiology. The study aim was to evaluate the presence, associations, and prognostic significance of diffuse fibrosis in HFpEF patients compared to age- and sex-matched control...

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Veröffentlicht in:Journal of cardiovascular magnetic resonance Jg. 20; H. 1; S. 55 - 12
Hauptverfasser: Roy, Clotilde, Slimani, Alisson, de Meester, Christophe, Amzulescu, Mihaela, Pasquet, Agnes, Vancraeynest, David, Beauloye, Christophe, Vanoverschelde, Jean-Louis, Gerber, Bernhard L., Pouleur, Anne-Catherine
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London BioMed Central 08.08.2018
BioMed Central Ltd
Elsevier
Schlagworte:
Age
Aged
Aged, 80 and over
Analysis
Anemia
Angiology
Biopsy
Body mass index
Body size
Cardiac magnetic resonance
Cardiac output
Cardiology
Cardiomyopathy
Cardiovascular disease
Case-Control Studies
Cause of Death
Chronic obstructive pulmonary disease
Chronology
Control methods
Coronary vessels
Diabetes
Diabetes mellitus
Diagnosis
Diffuse myocardial fibrosis
Disease Progression
Ejection fraction
Female
Fibrosis
Heart
Heart diseases
Heart failure
Heart Failure - diagnostic imaging
Heart Failure - pathology
Heart Failure - physiopathology
Heart Failure - therapy
Hemoglobin
Hospitalization
Humans
Imaging
Magnetic resonance
Magnetic resonance imaging
Magnetic Resonance Imaging, Cine
Male
Medical prognosis
Medicine
Medicine & Public Health
Mortality
Myocardium - pathology
Older people
Patients
Predictive Value of Tests
Prognosis
Prospective Studies
Radiology
Registration
Regression analysis
Risk Factors
Sex
Statistical analysis
Stroke Volume
Time Factors
Ventricular Function, Left
Ventricular Remodeling
Prognosis
Cardiac magnetic resonance
Diffuse myocardial fibrosis
ISSN:1097-6647, 1532-429X, 1532-429X
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Zusammenfassung:Background Increased myocardial fibrosis may play a key role in heart failure with preserved ejection fraction (HFpEF) pathophysiology. The study aim was to evaluate the presence, associations, and prognostic significance of diffuse fibrosis in HFpEF patients compared to age- and sex-matched controls. Methods We prospectively included 118 consecutive HFpEF patients. Diffuse myocardial fibrosis was estimated by extracellular volume (ECV) quantified by cardiovascular magnetic resonance with the modified Look-Locker inversion recovery sequence. We determined an ECV age- and sex-adjusted cutoff value (33%) in 26 controls. Results Mean ECV was significantly higher in HFpEF patients versus healthy controls (32.9 ± 4.8% vs 28.2 ± 2.4%, P  <  0.001). Multivariate logistic regression showed that body mass index (BMI) (odds ratio (OR) =0.92 [0.86–0.98], P  = 0.011), diabetes (OR = 2.62 [1.11–6.18], P  = 0.028), and transmitral peak E wave velocity (OR = 1.02 [1.00–1.03], P  = 0.022) were significantly associated with abnormal ECV value. During a median follow-up of 11 ± 6 months, the primary outcome (all-cause mortality or first heart failure hospitalization) occurred in 38 patients. In multivariate Cox regression analysis, diabetes (hazard ratio (HR) =1.98 [1.04; 3.76], P  = 0.038) and hemoglobin level (HR = 0.81 [0.67; 0.98], P  = 0.028) were significant predictors of composite outcome. The ECV ability to improve this model added significant prognostic information. We then developed a risk score including diabetes, hemoglobin and ECV > 33% demonstrating significant prediction of risk and validated this score in a validation cohort of 53 patients. Kaplan–Meier curves showed a significant difference according to tertiles of the probability score ( P  <  0.001). Conclusion Among HFpEF patients, high ECV, likely reflecting abnormal diffuse myocardial fibrosis, was associated with a higher rate of all-cause death and first HF hospitalization in short term follow up. Trial registration Characterization of Heart Failure With Preserved Ejection Fraction. Trial registration number: NCT03197350 . Date of registration: 20/06/2017. This trial was retrospectively registered.
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ISSN:1097-6647
1532-429X
1532-429X
DOI:10.1186/s12968-018-0477-4