The clinical and prognostic value of late Gadolinium enhancement imaging in heart failure with mid-range and preserved ejection fraction
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Key result
LGE on CMR linked to ~5-fold higher mortality in HF patients with LVEF > 40%.
- HR 5.3
- 95% CI 1.5-18.1
- P=0.009
- n=110
Why the study?
Heart failure with mid-range or preserved ejection fraction is heterogeneous and could benefit from strategies to identify subpopulations at increased risk of all-cause mortality using late gadolinium enhancement.
Does the presence of myocardial scar on late gadolinium enhancement CMR predict all-cause mortality in patients with heart failure and LVEF > 40%?
Population
110 consecutive symptomatic HF patients with LVEF > 40%
Comparison
Presence vs absence of myocardial LGE lesions
Design
Cohort study
Authors
Discussion
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Implication
May support CMR risk stratification in HF with LVEF >40%; hypothesis-generating and requires prospective validation.
Study Design
Type
Cohort (n=110)
Multicenter
No
Structured PICO
Does the presence of myocardial scar on late gadolinium enhancement CMR predict all-cause mortality in patients with heart failure and LVEF > 40%?
P
Population
110 symptomatic heart failure patients (NYHA class ≥2) with LVEF > 40% (HFmrEF and HFpEF), NT-proBNP > 125 pg/ml, and evidence of LV diastolic dysfunction, left atrial dilatation, and/or LV hypertrophy. Mean age 71 ± 10 years, 49% female, based in the Netherlands. Excluded: LVEF ≤ 40%, congenital heart disease, genetically proven hypertrophic or dilated cardiomyopathy, >moderate left-sided valvular disease, and myocardial infarction < 3 months prior.
I
Intervention
Presence of myocardial scars detected with late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging
C
Comparator
Absence of myocardial scars (LGE lesions) on cardiac magnetic resonance (CMR) imaging
O
Outcome
All-cause mortality at median 34 months follow-uphard clinical
Main Result
Effect estimate: HR 5.3 (95% CI 1.5-18.1)
p-value: p=0.009
Myocardial scarring detected by late gadolinium enhancement on CMR is a strong, independent predictor of all-cause mortality in patients with heart failure and LVEF > 40%.
Limitations
- Retrospective nature of the study
- T1/ECV mapping was only available in 75 out of 110 patients
- Relatively small sample size
- Lower mortality rate than in most HFmrEF/HFpEF trials
- Lack of a control group without heart failure
- Retrospective nature
- T1/ECV mapping only available in 75 out of 110 patients
- Lower mortality rate than most HFmrEF/HFpEF trials
- No control group without HF
Cite This Study
Woerden et al. (2021) conducted a cohort in Heart failure with mid-range and preserved ejection fraction (n=110). Presence of late gadolinium enhancement (LGE) lesions vs. Absence of LGE lesions was evaluated on All-cause mortality (HR 5.3, 95% CI 1.5-18.1, p=0.009). The presence of late gadolinium enhancement lesions on cardiac magnetic resonance imaging was associated with a fivefold increase in all-cause mortality (HR 5.3) in heart failure patients with LVEF > 40%.
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