What does this research mean for the field?

Diffuse myocardial fibrosis (indicated by short T1 time) in LGE-positive heart failure patients is associated with elevated galectin-3 levels and a higher risk of adverse events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 22, 2023BiomoleculesOpen Access

Diffuse Myocardial Fibrosis on Cardiac Magnetic Resonance Imaging Is Related to Galectin-3 and Predicts Outcome in Heart Failure

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=159). Intervention: Shorter post-contrast T1 time (diffuse fibrosis) vs. Longer post-contrast T1 time. Primary outcome: Composite of HF hospitalization and all-cause mortality (HR 1.09, 95% CI 1.02-1.18, p=0.013).

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Key result

Shorter post-contrast T1 time linked to ~9% higher HF hospitalization and death per 10 ms decrease.

HR 1.09
95% CI 1.02-1.18
P=0.013
n=159

Why the study?

Ongoing adverse remodeling is a hallmark of heart failure, which might be reflected by either focal or diffuse myocardial fibrosis.

Does diffuse myocardial fibrosis assessed by post-contrast T1 time on CMR predict adverse outcomes and correlate with galectin-3 in heart failure patients?

Population

159 outpatient HF patients who underwent CMR and C57Bl/6J mice 6 weeks post-MI

Comparison

Stratification by presence of LGE and median post-contrast T1 time of non-LGE myocardium

Design

Preclinical and clinical observational cohort study

Authors

ESElles M. ScreeverErasmus MC Cancer Institute TGThomas M. GorterHeart Failure & Transplant TWTineke P. WillemsCardiac Imaging

Discussion

Member takes

Implication

May refine prognosis in scarred HF; hypothesis-generating for diffuse fibrosis assessment and galectin-3 links.

Study Design

Type

Cohort (n=159)

Multicenter

Structured PICO

Does diffuse myocardial fibrosis assessed by post-contrast T1 time on CMR predict adverse outcomes and correlate with galectin-3 in heart failure patients?

Population

159 outpatient heart failure patients who underwent cardiac magnetic resonance imaging, followed for a median of 2.6 years.

Exposure

Assessment of diffuse myocardial fibrosis using post-contrast T1 time of the non-late gadolinium enhancement (LGE) myocardium on CMR.

Comparator

Patients with longer post-contrast T1 time (less diffuse fibrosis) or patients without focal scarring (LGE-negative).

Outcome

Composite of heart failure hospitalization and all-cause mortality, first to occur, at a median follow-up of 2.6 years.composite

Main Result

Hazard Ratio: 1.09 (95% CI 1.02–1.18)

Absolute Event Rate: 43% vs 14%

p-value: p=0.013

Diffuse myocardial fibrosis assessed by CMR post-contrast T1 time correlates with galectin-3 levels and predicts heart failure hospitalization and mortality in patients with focal myocardial scarring.

Limitations

Limited number of outpatient HF patients, preventing multivariable-adjusted analyses
Relationship of diffuse fibrosis with outcomes only observed in HF patients with focal myocardial scarring
Retrospective nature prevented determining relation with other biomarkers like ST2 and GDF-15
T1-based indices may be affected by other pathological processes like edema and depend on CMR equipment
Only post-contrast T1 time was determined, not extracellular volume (ECV)
Limited number of outpatient HF patients preventing multivariable-adjusted analyses
Relationship of diffuse fibrosis with outcomes only observed in HF patients with focal myocardial scarring (LGE-positive)
T1-based indices may be affected by other pathological processes (e.g., edema) and are highly dependent on CMR equipment
Only post-contrast T1 time was determined, while extracellular volume (ECV) is increasingly being used

Cite This Study

Screever et al. (2023) conducted a cohort in Heart failure (n=159). Shorter post-contrast T1 time (diffuse fibrosis) vs. Longer post-contrast T1 time was evaluated on Composite of HF hospitalization and all-cause mortality (HR 1.09, 95% CI 1.02-1.18, p=0.013). Shorter post-contrast T1 time (diffuse fibrosis) increased the risk of heart failure hospitalization and mortality in heart failure patients with focal scarring (HR 1.09 per 10 ms decrease, p=0.013).

synapsesocial.com/papers/6a18abdc673175fe754ac2b9 https://doi.org/10.3390/biom13030410

Topics

Cardiomyopathy Heart failure HFrEF treatment Cardiac amyloidosis

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Diffuse Myocardial Fibrosis on Cardiac Magnetic Resonance Imaging Is Related to Galectin-3 and Predicts Outcome in Heart Failure

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Diffuse Myocardial Fibrosis on Cardiac Magnetic Resonance Imaging Is Related to Galectin-3 and Predicts Outcome in Heart Failure

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider