Left Ventricular Diastolic Volume on Cardiac Magnetic Resonance and Risk of Incident Heart Failure

Aims We explored the association between indexed left ventricular end-diastolic volume (iLVEDV) on cardiac magnetic resonance (CMR) and the risk of incident heart failure (HF) (stage C) in patients with suspected coronary heart disease without overt HF (stages A-B). We also examined the risk-modifying effect of left ventricular ejection fraction (LVEF) and sex. Methods We retrospectively included 5,471 patients who underwent vasodilator stress CMR for suspected coronary artery disease and without a history of HF. Multivariate Cox proportional hazards regression adapted for competing events models assessed the relationship between iLVEDV and new-onset HF (stage C), considering LVEF status as potential modifier. Results The mean age was 65.1±11.6 years, and 2,123 (38.8%) were women. The medians of CMR-iLVEDV and CMR-LVEF were 67 ml/m2 (55-80) and 66% (58-72), respectively. At a median (p25% to p75%) follow-up of 5.1 years (2.3-8.2), we registered 287 new-onset HF diagnosis. iLVEDV was associated with a U-shaped risk of incident HF. The risk was most pronounced with an iLVEDV>100 ml/m2 and <45 ml/m2. Notably, the association between iLVEDV and HF risk was influenced by LVEF status. In patients with LVEF<50%, a higher risk was found in those with larger iLVEDV. On the contrary, LVEF>60%, lower iLVEDV identified those at increased risk. Conclusions In subjects with higher LVEF, smaller left ventricle volumes identified a subset of patients with an increased risk of incident HF. These findings reveal a need for a better understanding of the pathophysiological mechanisms of HF with supranormal ejection fraction.