Elsevier

JACC: Cardiovascular Imaging

Volume 14, Issue 12, December 2021, Pages 2319-2333
JACC: Cardiovascular Imaging

Original Research
Long-Term Prognostic Value of Stress CMR in Patients With Heart Failure and Preserved Ejection Fraction

https://doi.org/10.1016/j.jcmg.2021.03.010Get rights and content
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Abstract

Objectives

The objectives of this study were to investigate the long-term prognostic value of inducible myocardial ischemia assessed by vasodilator stress cardiovascular magnetic resonance (CMR) in patients with HFpEF.

Background

Some studies suggest that ischemia could play a key role in HF in patients with preserved ejection fraction (HFpEF).

Methods

Between 2008 and 2019, consecutive patients prospectively referred for stress CMR with HFpEF as defined by current guidelines, without known coronary artery disease (CAD), were followed for the occurrence of major adverse cardiovascular events (MACE), as defined by cardiovascular mortality or nonfatal myocardial infarction (MI). Secondary composite outcomes included cardiovascular mortality or hospitalization for acute HF. Cox regression analysis was performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR.

Results

Among the 1,203 patients with HFpEF (73 ± 13 years of age; 29% males) who underwent stress CMR and completed follow-up (6.9 years interquartile range [IQR]: 6.7 to 7.7 years]), 108 experienced a MACE (9%). Kaplan-Meier analysis showed inducible ischemia and LGE were significantly associated with MACE (HR: 6.63; 95% confidence interval [CI]: 4.54 to 9.69; and HR: 2.56; 95% CI: 1.60 to 4.09, respectively; both p < 0.001) and secondary outcomes (HR: 8.40; 95% CI: 6.31 to 11.20; p < 0.001; and HR: 1.87; 95% CI: 1.27 to 2.76, respectively; p = 0.002). In multivariate analysis, inducible ischemia and LGE were independent predictors of MACE (HR: 6.10; 95% CI: 4.14 to 9.00; p < 0.001 and HR: 1.62; 95% CI: 1.06 to 2.49; p = 0.039; respectively).

Conclusions

Stress CMR-inducible myocardial ischemia and LGE have accurate discriminative long-term prognostic value in HFpEF patients without known CAD to predict the occurrence of MACE.

Key Words

cardiovascular event(s)
cardiovascular magnetic resonance
dipyridamole
HF
HFpEF
stress testing

Abbreviations and Acronyms

CAD
coronary artery disease
CMR
cardiovascular magnetic resonance
MACE
major adverse cardiac event(s)
LGE
late gadolinium enhancement
LV
left ventricle
LVEF
left ventricular ejection fraction
HF
heart failure
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
MI
myocardial infarction

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