Abstract 14088: Ventricular Longitudinal Function by CMR Predicts Heart Failure Associated Morbidity in Patients With Heart Failure and Reduced Ejection Fraction

Abstract

Ventricular longitudinal function measured as basal-apical atrioventricular plane displacement (AVPD) or global longitudinal strain (GLS) are potent predictors of mortality and could potentially be predictors of morbidity in heart failure (HF). We hypothesize that decreased AVPD and GLS are associated with increased morbidity measured. Patients with HFrEF (EF≤40%) referred to a CMR exam were considered for inclusion. Ventricular longitudinal function, ventricular volumes and myocardial fibrosis or infarctions were analyzed. National registries provided data on cause of cardiovascular hospitalizations and cardiovascular mortality and this was used as a composite endpoint. A time-to-event analysis capable of including reoccurring events were employed with 5-year follow-up. HFrEF patients (n=287, age 62±12, 78% male) had EF 26.5% (SEM 0.5), AVPD 7.8 mm (SEM 0.1) and GLS -7.5% (SEM 0.2). There were 578 events in total and the vast majority was HF hospitalizations (n=418). Other major events were revascularizations (n=64), cardiovascular deaths (n=40) and myocardial infarctions (n=21), and 155 (54%) patients experienced at least one event (Mean 2.0, range 0-64). Patients in the bottom AVPD or GLS tertile (<6.8mm or >-6.1%) experienced over 3 times as many events compared to the top tertile (>8.8 mm or <-8.4%, p<0.001) (Figure 1). In multivariate analysis adjusted for significant variables, AVPD and GLS remained as independent predictors of events (HR 1.12 per-mm-decrease and HR 1.13 per-%-increase) (Table 1). In conclusion, ventricular longitudinal function, measured either as AVPD or GLS, have independently prognostic implications for morbidity in HFrEF patients.