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

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...

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Autores principales: Garg, Pankaj, Assadi, Hosamadin, Jones, Rachel, Chan, Wei Bin, Metherall, Peter, Thomas, Richard, van der Geest, Rob, Swift, Andrew J., Al-Mohammad, Abdallah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804435/
https://www.ncbi.nlm.nih.gov/pubmed/33436786
http://dx.doi.org/10.1038/s41598-020-79729-6
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author Garg, Pankaj
Assadi, Hosamadin
Jones, Rachel
Chan, Wei Bin
Metherall, Peter
Thomas, Richard
van der Geest, Rob
Swift, Andrew J.
Al-Mohammad, Abdallah
author_facet Garg, Pankaj
Assadi, Hosamadin
Jones, Rachel
Chan, Wei Bin
Metherall, Peter
Thomas, Richard
van der Geest, Rob
Swift, Andrew J.
Al-Mohammad, Abdallah
author_sort Garg, Pankaj
collection PubMed
description 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.
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spelling pubmed-78044352021-01-13 Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction Garg, Pankaj Assadi, Hosamadin Jones, Rachel Chan, Wei Bin Metherall, Peter Thomas, Richard van der Geest, Rob Swift, Andrew J. Al-Mohammad, Abdallah Sci Rep Article 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. Nature Publishing Group UK 2021-01-12 /pmc/articles/PMC7804435/ /pubmed/33436786 http://dx.doi.org/10.1038/s41598-020-79729-6 Text en © The Author(s) 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Garg, Pankaj
Assadi, Hosamadin
Jones, Rachel
Chan, Wei Bin
Metherall, Peter
Thomas, Richard
van der Geest, Rob
Swift, Andrew J.
Al-Mohammad, Abdallah
Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction
title 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_short 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
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804435/
https://www.ncbi.nlm.nih.gov/pubmed/33436786
http://dx.doi.org/10.1038/s41598-020-79729-6
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