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Prognostic value of mean velocity at the pulmonary artery estimated by cardiovascular magnetic resonance as a prognostic predictor in a cohort of patients with new-onset heart failure with reduced ejection fraction.

ABSTRACT: BACKGROUND:Pulmonary hypertension (PH) conveys a worse prognosis in heart failure (HF), in particular when right ventricular (RV) dysfunction ensues. Cardiovascular magnetic resonance (CMR) non-invasively estimates pulmonary vascular resistance (PVR), which has shown prognostic value in HF. Importantly, RV to pulmonary artery (PA) coupling is altered early in HF, before significant rise in PV resistance occurs. The aim of this study was to assess the prognostic value of mean velocity at the pulmonary artery (mvPA), a novel non-invasive parameter determined by CMR, in HF with reduced ejection fraction (HFrEF) with and without associated PH. METHODS:Prospective inclusion of 238 patients admitted for new-onset HFrEF. MvPA was measured with CMR during index admission. The primary endpoint was defined as a composite of HF readmissions and all-cause mortality. RESULTS:During a median follow-up of 25?months, 91 patients presented with the primary endpoint. Optimal cut-off value of mvPA calculated by the receiver operator curve for the prediction of the primary endpoint was 9?cm/s. The primary endpoint occurred more frequently in patients with mvPA?9?cm/s, as indicated by Kaplan-Meier survival curves; Log Rank 16.0, p?

SUBMITTER: Trejo-Velasco B

PROVIDER: S-EPMC7191770 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Prognostic value of mean velocity at the pulmonary artery estimated by cardiovascular magnetic resonance as a prognostic predictor in a cohort of patients with new-onset heart failure with reduced ejection fraction.

Trejo-Velasco Blanca B Fabregat-Andrés Óscar Ó García-González Pilar M PM Perdomo-Londoño Diana C DC Cubillos-Arango Andrés M AM Ferrando-Beltrán Mónica I MI Belchi-Navarro Joaquina J Pérez-Boscá José L JL Payá-Serrano Rafael R Ridocci-Soriano Francisco F

Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance 20200430 1

<h4>Background</h4>Pulmonary hypertension (PH) conveys a worse prognosis in heart failure (HF), in particular when right ventricular (RV) dysfunction ensues. Cardiovascular magnetic resonance (CMR) non-invasively estimates pulmonary vascular resistance (PVR), which has shown prognostic value in HF. Importantly, RV to pulmonary artery (PA) coupling is altered early in HF, before significant rise in PV resistance occurs. The aim of this study was to assess the prognostic value of mean velocity at ...[more]

PMID: 32354373

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Project description:BackgroundIncreased myocardial fibrosis may play a key role in heart failure with preserved ejection fraction (HFpEF) pathophysiology. The study aim was to evaluate the presence, associations, and prognostic significance of diffuse fibrosis in HFpEF patients compared to age- and sex-matched controls.MethodsWe prospectively included 118 consecutive HFpEF patients. Diffuse myocardial fibrosis was estimated by extracellular volume (ECV) quantified by cardiovascular magnetic resonance with the modified Look-Locker inversion recovery sequence. We determined an ECV age- and sex-adjusted cutoff value (33%) in 26 controls.ResultsMean ECV was significantly higher in HFpEF patients versus healthy controls (32.9 ± 4.8% vs 28.2 ± 2.4%, P < 0.001). Multivariate logistic regression showed that body mass index (BMI) (odds ratio (OR) =0.92 [0.86-0.98], P = 0.011), diabetes (OR = 2.62 [1.11-6.18], P = 0.028), and transmitral peak E wave velocity (OR = 1.02 [1.00-1.03], P = 0.022) were significantly associated with abnormal ECV value. During a median follow-up of 11 ± 6 months, the primary outcome (all-cause mortality or first heart failure hospitalization) occurred in 38 patients. In multivariate Cox regression analysis, diabetes (hazard ratio (HR) =1.98 [1.04; 3.76], P = 0.038) and hemoglobin level (HR = 0.81 [0.67; 0.98], P = 0.028) were significant predictors of composite outcome. The ECV ability to improve this model added significant prognostic information. We then developed a risk score including diabetes, hemoglobin and ECV > 33% demonstrating significant prediction of risk and validated this score in a validation cohort of 53 patients. Kaplan-Meier curves showed a significant difference according to tertiles of the probability score (P < 0.001).ConclusionAmong HFpEF patients, high ECV, likely reflecting abnormal diffuse myocardial fibrosis, was associated with a higher rate of all-cause death and first HF hospitalization in short term follow up.Trial registrationCharacterization of Heart Failure With Preserved Ejection Fraction.Trial registration numberNCT03197350 . Date of registration: 20/06/2017. This trial was retrospectively registered.

Project description:BackgroundHeart failure with reduced ejection fraction (HFrEF) patients who have improved ejection fraction have a better prognosis than those with persistently reduced ejection fraction. This study aimed to analyze the predictors for progression of patients with HFrEF to heart failure with improved ejection fraction (HFimpEF), as well as their characteristics and analyze predictors for prognosis.MethodsA retrospective analysis was conducted on 1251 patients with HFrEF at baseline, who also had a second echocardiogram ≥ 3 months. After left ventricular ejection fraction (LVEF) reassessment, patients were separated into the HFimpEF group (n = 408) and the persistent HFrEF group (n = 611). The primary endpoint was a composite of cardiovascular death or heart failure hospitalization.ResultsMultivariate logistic regression showed that without history of alcohol consumption (OR: 0.47, 95% CI: 0.28-0.78), non-New York Heart Association (NYHA) class III-IV (OR: 0.28, 95% CI: 0.15-0.52), without dilated cardiomyopathy (OR: 0.47, 95% CI: 0.26-0.84), concomitant hypertension (OR: 1.53, 95% CI: 1.02-2.29), β -blockers use (OR: 2.29, 95% CI: 1.54-3.43), and lower uric acid (OR: 0.999, 95% CI: 0.997-1.000) could predict LVEF improvement. Kaplan-Meier curves demonstrated that HFimpEF patients had a significantly lower incidence of adverse events than HFrEF patients (log Rank p < 0.001). Multivariate Cox regression found that older age (HR: 1.04, 95% CI: 1.02-1.06), NYHA class III-IV (HR: 2.25, 95% CI: 1.28-3.95), concomitant valvular heart disease (HR: 1.98, 95% CI: 1.01-3.85), and higher creatinine (HR: 1.003, 95% CI: 1.001-1.004) were independent risk factors for the primary endpoint in HFimpEF patients.ConclusionsHFrEF patients without a history of alcohol consumption, non-NYHA class III-IV, without dilated cardiomyopathy, concomitant hypertension, β -blockers use, and lower uric acid were more likely to have LVEF improvement. Although the prognosis of HFimpEF patients was better than that of HFrEF patients, older age, NYHA class III-IV, concomitant valvular heart disease, and higher creatinine were still risk factors for cardiovascular events in HFimpEF patients.

Dataset Information

Prognostic value of mean velocity at the pulmonary artery estimated by cardiovascular magnetic resonance as a prognostic predictor in a cohort of patients with new-onset heart failure with reduced ejection fraction.

Publications

Prognostic value of mean velocity at the pulmonary artery estimated by cardiovascular magnetic resonance as a prognostic predictor in a cohort of patients with new-onset heart failure with reduced ejection fraction.

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