Abstract 16511: Myocardial Damage Detected by Late Gadolinium Enhancement Cardiovascular Magnetic Resonance is Associated With Incident Hospitalization for Heart Failure
Background: Hospitalization for heart failure (HHF) is among the most important problems confronting medicine. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) robustly identifies scar and may indicate intrinsic myocardial damage and fundamental vulnerability to HHF, regardless of etiology, across the spectrum of heart failure stage or left ventricular ejection fraction (LVEF).
Methods and Results: We enrolled 1,068 consecutive patients referred for CMR where 448 exhibited LGE. After a median of 1.4 years (IQR 0.9-2.0 yrs), 57 HHF events occurred, 15 deaths followed HHF, and 43 deaths occurred without prior HHF (58 total deaths). Using Cox regression adjusting for LVEF, heart failure stage, and other covariates, LGE was associated with incident HHF (HR 2.70, 95%CI 1.32-5.50), death (HR 2.13, 95%CI 1.08-4.21), or either death or HHF (HR 2.52, 95%CI 1.49-4.25). LGE related to outcomes, regardless of whether LVEF was preserved (Figure 1). In patients with LVEF ≤ 30%, those without LGE (n=20 of 102) had no events at 2 years, but 33 of 82 patients with LGE had events. Quantifying extent of LGE yielded similar results, where more LGE equated higher risks. Adding LGE to the fully adjusted model for HHF increased discrimination (IDI 0.016, p =0.002) and improved classification of individuals at risk: continuous NRI 0.40 (p=0.024); categorical NRI 0.15(p=0.006). Adjustment for competing risks of death which share common risk factors with HHF strengthened the association between LGE and HHF (HR 4.85, 95%CI 1.40-16.9).
Conclusions: The presence and extent of LGE is associated with fundamental vulnerability for HHF and higher risks of HHF across the spectrum of heart failure stage and LVEF. Those without LGE appear to fare well even when LVEF is severely decreased. LGE assessment may enhance our ability to stratify risk of HHF and may be relevant for both clinical and research efforts to reduce HHF through targeted treatment.
- © 2013 by American Heart Association, Inc.