France: A recent study found that stress cardiovascular magnetic resonance (CMR)-inducible myocardial ischemia and late gadolinium enhancement (LGE) may predict the occurrence of major adverse cardiac events (MACE) in HFpEF patients. The study appears in the journal JACC: Cardiovascular Imaging.
Previous studies have suggested that ischemia could play a critical role in heart failure in patients with preserved ejection fraction (HFpEF). Théo Pezel, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France, and colleagues aimed to investigate the long-term prognostic value of inducible myocardial ischemia assessed by vasodilator stress CMR in patients with HFpEF.
The study included consecutive patients prospectively referred for stress CMR with HFpEF as defined by current guidelines, without known coronary artery disease (CAD) between 2008 and 2019. They were followed for the occurrence of MACE, as defined by cardiovascular mortality or nonfatal myocardial infarction (MI).
Secondary composite outcomes included cardiovascular mortality or hospitalization for acute HF. The prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR was determined.
The study revealed the following 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 and HR: 2.56, respectively) and secondary outcomes (HR: 8.40 and HR: 1.87, respectively).
In multivariate analysis, inducible ischemia and LGE were independent predictors of MACE (HR: 6.10 and HR: 1.62 respectively).
"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," the authors concluded.
Reference:
The study titled, 'Long-Term Prognostic Value of Stress CMR in Patients With Heart Failure and Preserved Ejection Fraction," was published in the journal JACC: Cardiovascular Imaging.
DOI: https://www.jacc.org/doi/10.1016/j.jcmg.2021.03.010