Combined high-risk myocardial perfusion reserve and extracellular volume fraction was associated with increased risk of mortality or heart failure hospitalization (HR 4.01; 95% CI 2.28-7.03; p<0.001).
Cohort (n=677)
Does the combination of quantitative perfusion CMR and T1 mapping improve prognostic risk stratification in patients with heart failure?
Combining quantitative perfusion CMR and T1 mapping provides incremental prognostic value over conventional parameters for predicting adverse outcomes in heart failure patients.
Hazard Ratio: 4.01 (95% CI 2.28–7.03)
p-value: p=<0.001
Background Alterations in myocardial perfusion and fibrosis are key components in the pathophysiology of heart failure (HF). However, the incremental prognostic value of combining myocardial perfusion and fibrosis remains unclear. The purpose of this study was to evaluate the incremental prognostic value of myocardial perfusion and diffuse fibrosis as defined by cardiovascular magnetic resonance (CMR) in patients with HF. Materials and Methods We collected data from prospectively recruited patients who were clinically diagnosed with HF and referred for CMR assessment between November 2017 to April 2024. Stress/rest myocardial blood flow (MBF) and perfusion reserve (MPR) were calculated from QP-CMR. Extracellular volume fraction (ECV) was calculated using T1 mapping. The primary endpoint was defined as a composite of HF hospitalization (HFH) and all-cause mortality, based on the timing of the first event. Univariate and multivariate Cox regression analysis, and global chi-square analysis were used to assess prognostic performance. Results A total of 677 patients with HF (median (interquartile range) 63.2 (55.2–72.3) years; 436 male.) were enrolled. During a median 3.5 year follow-up, 109 patients (16.1%) reached the primary endpoints (59 deaths and 50 HFHs). Lower tertile of MPR adjusted hazard ratio (aHR) 1.74 (95% confidence interval 1.18–2.56), p=0.005) and higher tertiles of native T1 [aHR 1.74 (1.16–2.59), p=0.007 and ECV aHR 2.35 (1.58–3.49), p<0.001 were associated with the occurrence of the primary endpoint, whereas stress and rest MBF were not significantly associated. Patients exhibiting both high-risk MPR and high-risk ECV had the poorest prognosis aHR 4.01 (2.28–7.03), p<0.001 whereas patients with only isolated high-risk MPR (aHR 1.74 (1.06–2.86), p=0.027), or high-risk ECV aHR 2.36(1.36–4.09), p=0.002 demonstrated significantly worse prognoses than patients with both parameters within the low-risk range. Adding ECV to age, sex, and conventional parameters increased the global chi-square values from 33.79 to 50.34 (p<0.001), and further addition of MPR to 57.78 (p=0.006). Conclusions QP-CMR and T1 mapping provide incremental, complementary prognostic information for predicting adverse outcomes in HF patients. Impaired myocardial perfusion may be an important marker for risk stratification in addition to myocardial fibrosis in HF patients.
Takafuji et al. (Mon,) conducted a cohort in Heart failure (n=677). High-risk myocardial perfusion reserve (MPR) and extracellular volume fraction (ECV) vs. Low-risk MPR and ECV was evaluated on Composite of heart failure hospitalization and all-cause mortality (aHR 4.01, 95% CI 2.28-7.03, p=<0.001). Combined high-risk myocardial perfusion reserve and extracellular volume fraction was associated with increased risk of mortality or heart failure hospitalization (HR 4.01; 95% CI 2.28-7.03; p<0.001).