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Myocardial Damage Detected by Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Is Associated With Subsequent Hospitalization for Heart Failure
Study Questions:
Does late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging identify patients at risk of hospitalization for heart failure (HHF)?
Methods:
This prospective study examined 1,068 individuals undergoing a clinically indicated CMR study, after exclusion of patients with congenital heart disease or without available follow-up. HHF and mortality outcomes were assessed in patients stratified by the presence and extent of LGE.
Results:
From the total population of 1,068 patients, LGE was observed in 448 cases (42%). During a median follow-up of 1.4 years, there were 57 HHF events and 58 total deaths, including 15 deaths following HHF. After adjustment for ejection fraction, heart failure severity, and comorbidities, the presence of any LGE was associated with increased HHF (hazard ratio [HR], 2.7; 95% confidence interval [CI], 1.3-5.5; p = 0.006), death (HR, 2.1; 95% CI, 1.1-4.2; p = 0.03), and a composite of HHF or death (HR, 2.5; 95% CI, 1.5-4.3; p < 0.001). After multivariable adjustment, increased extent of LGE (as % of left ventricular [LV] mass) was associated with increased HHF (HR, 1.2 per +10%; 95% CI, 1.03-1.3; p = 0.02), death (HR, 1.3 per +10%; 95% CI, 1.1-1.5; p < 0.001), and HHF or death (HR, 1.1 per +10%; 95% CI, 1.03-1.2; p = 0.003). The use of LGE improved model discrimination (integrated discrimination improvement, 0.016; p = 0.002) and reclassification of risk (continuous net reclassification improvement, 0.40; p = 0.02).
Conclusions:
The presence and extent of LGE by CMR can identify patients at increased risk of adverse events including HHF and death in a population undergoing clinically indicated CMR.
Perspective:
This study finds that LGE on CMR can identify a cohort of patients at increased risk of death and HHF, regardless of whether patients had normal or reduced LV function, or had ischemic or nonischemic cardiomyopathy. Further, even in patients with severely decreased LV systolic function, the presence of LGE was able to identify patients at high or low risk of adverse events. While HHF is a large driver of health care costs and is associated with significant morbidity and mortality, it is challenging to accurately identify patients at risk of future HHF using clinical variables alone. These results suggest that the addition of LGE by CMR to clinical risk models may improve our ability to identify patients at higher risk of adverse events. Further research in multicenter populations is needed to determine whether the addition of LGE imaging can improve our ability to discriminate risk and improve outcomes.
Clinical Topics: Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Congenital Heart Disease, CHD and Pediatrics and Imaging, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Magnetic Resonance Imaging
Keywords: Follow-Up Studies, Heart Defects, Congenital, Salmonella Infections, Cardiomyopathies, Gadolinium, Heart Failure, Comorbidity, Confidence Intervals, Magnetic Resonance Spectroscopy, Magnetic Resonance Imaging, Systole
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