What is the clinical evidence from this study?

Study design: Cohort. Population: acute decompensated heart failure (n=284). Intervention: Myocardial extracellular volume (ECV) fraction and Serum TMAO. Primary outcome: Composite of all-cause death and HF rehospitalisation (HR 2.85, 95% CI 1.21-6.70).

What does this research mean for the field?

Serum TMAO, hs-CRP, and NT-proBNP are independent factors associated with myocardial extracellular volume fraction, which is linked to worse outcomes in heart failure patients. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to identify factors associated with myocardial extracellular volume fraction and their prognostic implications in heart failure patients.

February 6, 2026

The independent factors associated with myocardial extracellular volume fraction in acute decompensated heart failure patients

Key Result

Myocardial extracellular volume fraction was independently associated with a higher risk of all-cause death and heart failure rehospitalization (per doubling, HR 2.85; 95% CI 1.21-6.70).

Key Points

This study aims to identify factors associated with myocardial extracellular volume fraction and their prognostic implications in heart failure patients.
Prospective cohort study with 284 heart failure patients
Evaluation of myocardial extravascular volume fraction using cardiovascular magnetic resonance (CMR)
Analysis of TMAO levels via liquid chromatography-time of flight mass spectrometry
Follow-up assessment for composite outcomes including death and rehospitalization
38.4% of patients reached composite primary outcomes during median follow-up of 14.1 months
ECV fraction significantly associated with primary outcomes (HR 4.55) but weakened in multivariate analysis (HR 2.85)
Independent risk factors include TMAO, age, and hs-CRP levels, with higher LVEF linked to lower risk
hs-CRP, NT-proBNP, and TMAO levels independently associated with myocardial ECV fraction

Study Design

Type

Cohort (n=284)

Structured PICO

Population

284 patients with acute decompensated heart failure who underwent cardiovascular magnetic resonance (CMR) examination

Outcome

Composite events consisting of all-cause death and HF rehospitalisation during follow-upcomposite

Myocardial extracellular volume fraction, which correlates with serum TMAO, hs-CRP, and NT-proBNP levels, is an independent predictor of death and rehospitalization in patients with acute decompensated heart failure.

Main Result

Effect estimate: HR 2.85 (95% CI 1.21-6.70)

Abstract

Abstract Background Myocardial eextracellular volume (ECV) fraction is an important metric for myocardial fibrosis. However, the associated factors for the level of ECV had not been fully explored. Purpose This study focuses on the connection between trimethylamine-N-oxide (TMAO) and myocardial ECV, and their effects in the prognosis of heart failure (HF). Methods The prospective cohort study included 284 HF patients with cardiovascular magnetic resonance (CMR) examination for analysis. Myocardial ECV fraction was evaluated by CMR. Serum TMAO was analyzed using liquid chromatography-time of flight mass spectrometry. The primary end-points were defined as a composite events consisting of all-cause death and HF rehospitalisation during follow-up. Results In a median follow-up duration of 14.1 months, 109 (38.4%) patients reached the composite primary outcomes as defined. In univariate Cox regression models, ECV fraction showed a most significant strength of association (per doubling, HR 4.55, 95%CI 1.96–10.60) with the primary outcomes in HF, and weakened in multivariate Cox regression models (per doubling, HR 2.85, 95%CI 1.21–6.70). Other independent risk factors including TMAO, age, and higher hs-CRP, while higher level of LVEF was associated with a lower risk of primary outcomes. Multivariate linear regression analysis showed that levels of hs-CRP (rpartial=0.13, P=0.035), NT-proBNP (rpartial=0.19, P=0.001) and TMAO (rpartial=0.17, P=0.004), were independent factors associated with ECV fraction. Conclusion Serum TMAO, as well as levels of hs-CRP and NT-proBNP, could serve as independent factors associated with myocardial ECV fraction and is importantly associated with worse outcomes in patients with HF.

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