Key result
LV LGE burden ≥16% is linked to markedly fewer optimal echo and hemodynamic profiles post-LVAD.
Why the study?
LV fibrosis assessed by LGE at CMR is associated with HF outcomes and positive remodeling, but its impact in LVAD carriers remains to be evaluated.
Does higher left ventricular fibrosis burden (LGE ≥16%) reduce the likelihood of achieving optimal hemodynamic and echocardiographic profiles in patients undergoing LVAD implant?
Cohort (n=40)
No
Does higher left ventricular fibrosis burden (LGE ≥16%) reduce the likelihood of achieving optimal hemodynamic and echocardiographic profiles in patients undergoing LVAD implant?
Odds Ratio: 0.15 (95% CI 0.03–0.91)
Absolute Event Rate: 13.3% vs 50%
p-value: p=0.040
Higher left ventricular fibrosis burden assessed by CMR prior to LVAD implantation is inversely associated with positive myocardial remodeling and optimal hemodynamics at 6 months.
May predict poorer post-LVAD remodeling; extends observational fibrosis data but requires prospective validation.
Left Ventricular (LV) fibrosis assesed by late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) is associated with heart failure (HF) outcomes and positive remodeling. The aim of this study is to evaluate its impact in left ventricular device (LVAD) carriers. In this retrospective and single-center study, 278 patients underwent LVAD implant in Harefield Hospital and 44 had a CMR within 2 years before the device implant (median time 74 days, IQR 29-335). Fuor patients were excluded because of insufficient image quality, leading to a final cohort of 40 patients. At this point patients were dichotomized at the median LV LGE burden (16%). The association of pre-LVAD morpho-functional and LGE features with myocardial remodeling was analyzed. Coprimary outcomes were the optimal hemodynamic and echocardiographic profile at 6 months after LVAD implant. Optimal hemodynamic profile was defined as Cardiac Index≥2.2 L/min/m², pulmonary capillary pressure<18 mmHg, right atrial pressure<12 mmHg at right heart catheterization, while optimal echocardiographic profile was defined as neutral interventricular septum position, mitral regurgitation≤mild, and at least intermittent aortic valve opening. HF outcomes at 3 years were also evaluated. Ischemic heart disease was more common among patients with LGE≥16% (85% vs 30%, p-value<0.001). The presence of LGE burden≥16% was negatively associated with the achievement of optimal echocardiographic (13.3% vs 50.0%, p-value 0.029; OR 0.15, 95% CI 0.03-0.91, p-value 0.040) and hemodynamic profile (7.1% vs 42.9%, p-value 0.029; OR 0.11, 95% CI 0.27-0.95, p-value 0.034). In the univariate analysis several CMR variables including LV dimensions and mass, LGE burden, septal LGE involvement and number of segments with LGE were univariate predictors of coprimary outcomes. No difference in clinical outcomes was observed between groups. In conclusion: the burden of LV fibrosis assesed at CMR is inversely associated with positive myocardial remodeling and optimal hemodynamics among advanced HF patients undergoing durable mechanical unloading with an LVAD.
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Fini et al. (2025) conducted a cohort in Advanced heart failure (n=40). Left ventricular LGE burden ≥16% vs. Left ventricular LGE burden <16% was evaluated on Optimal echocardiographic profile at 6 months (OR 0.15, 95% CI 0.03-0.91, p=0.040). A pre-implant left ventricular LGE burden ≥16% was associated with significantly reduced odds of achieving an optimal echocardiographic (OR 0.15) and hemodynamic profile (OR 0.11) at 6 months.
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