Abstract 11833: Prognostic Value of Diffusion-Weighted Cardiac Magnetic Resonance Imaging in Hospitalized Heart Failure Patients

Abstract

Introduction: Diffusion-weighted imaging (DWI) has been recognized as the golden standard to detect acute phase cerebral infarction; however, there is a paucity of data regarding its utility in cardiac magnetic resonance (CMR). Hypothesis: We hypothesized that contrast-free DWI could detect underlying myocardial pathophysiology in patients with heart failure (HF). Methods: We included 90 hospitalized HF patients (mean age 62±13 years, 67% males, HFpEF/HFmrEF/HFrEF [N] 21/7/62) who underwent CMR with DWI and late gadolinium enhancement (LGE). We acquired 2 diffusion-weighted images (b=0 and 800 s/mm 2 ) to constitute apparent diffusion coefficient (ADC) map (Figure 1). ADC values were automatically calculated for five segments (basal septal, mid septal, apical, mid lateral, basal lateral) on 4-chamber planes. The association between minimum ADC values and major adverse cardiac events (MACE: all-cause mortality, HF hospitalization, or sustained ventricular arrhythmia/ICD shock) was investigated. Results: During a median follow-up of 18.1 months (IQR 9.3-32.1), 26 adverse events (8 all-cause deaths, 13 HF hospitalizations, and 5 ventricular arrhythmias) were detected in 20 patients. Event-rates were significantly higher in patients with minimum ADC value lower than median (=3490 mm 2 /s) than those with minimum ADC value higher than median (log-rank p=0.003) (Figure B). Lower minimum ADC value was associated with an increased risk of MACE (unadjusted HR 4.45, 95% confidence interval: [1.49-13.32]) and it remained significant even after adjustment for LGE. Minimum ADC values improved discrimination of risk for MACE after adding it to LGE (Figure C). Conclusions: Patients with lower minimum ADC values had an increased risk of MACE. DWI may potentially provide with incremental prognostic values over LGE in HF patients.