Abstract 13415: Is Late Gadolinium Enhancement by Cardiac Magnetic Resonance Really Helpful for Risk Stratification in Patients With Stable Heart Failure in Comparison With Usual Prognostic Factors ?
Objective: The aim of this study was to compare the prognostic value of late gadolinium enhancement (LGE) by cardiac magnetic resonance, B-type natriuretic peptide (BNP) and exercise capacity in patients (pts) with stable systolic heart failure (HF).
Background: Previous studies have demonstrated that these parameters are useful for risk stratification but no study has compared their respective prognostic value.
Methods: Pts (n=421) were consecutively included if they had a left ventricular ejection fraction (LVEF) ≤ 45% and received optimal medical therapy. All the pts underwent coronary angiography to assess etiology, cardiac magnetic resonance to assess the presence and extent of LGE, BNP measurement and cardiopulmonary exercise test. The endpoint was a composite of cardiovascular mortality, hospitalization for HF or non urgent heart transplantation.
Results: Mean age was 55 ± 13 years, mean LVEF was 36 ± 12%, 99.5% were receiving renin-angiotensin inhibitors and 94% beta-blockers. LGE was detected in 87% of pts with ischemic cardiopathy (n=191) and in 19% with non-ischemic cardiomyopathy (n=230). During a median follow-up period of 957 days, there were 109 cardiovascular events (58 cardiac deaths and 11 transplantations). The extent of LGE in ischemic group and the presence of LGE in non-ischemic group were not predictors of cardiac events. By multivariate analysis, BNP (RR=1.25 [95%CI=1.14–1.37]) and VE/VCO2 (RR=1.05 [95%CI=1.02–1.07]) were the most powerful independent predictors of cardiac event-free survival. The Figure illustrates the interest in combining both parameters for the risk stratification of stable pts with systolic HF.
Conclusion: In contrast to previous studies, LGE does not provide independent prognostic informations in pts with stable HF. BNP and VE/VCO2 slope remain the most powerful independent predictors of cardiac event-free survival.
- © 2010 by American Heart Association, Inc.