Abstract
Background: Myocardial scar as detected by cardiac magnetic resonance (CMR) has been documented to provide important diagnostic information in patients with heart failure (HF). What is less clear is its' prognostic value in this cohort of patients. Methods: A total of 153 consecutive patients with known or suspected HF referred for CMR imaging from 2005 to 2008 were prospectively followed for clinical events. The primary composite end point (EP) was all-cause mortality or unplanned cardiovascular hospitalization. Secondary composite EP included unplanned HF hospitalization, worsening of NYHA class or cardiac resynchronization therapy implantation. Patients were divided into two groups: late gadolinium enhancement (LGE) + and LGE- depending on the presence and absence of LGE respectively. Post-scan follow-up was assessed by review of case notes, clinic visits and review of the National Survival database. Results: LGE was present in 94 patients (61%). Of these, 53% had infarct, 26% had mid-wall and 8% had patchy distribution of LGE. The LGE+ patients were older, more likely to be male, with larger left ventricular (LV) volumes, increased LV mass and a lower LV ejection fraction. At a mean follow-up of 3.1 ± 1.4 years, 39 (41%) in the LGE+ and 10 (17%) in the LGE- groups experienced the primary EP. Forty-six (49%) in the LGE+ and 12 (20%) in the LGE- groups experienced the secondary EP. Kaplan-Meier analysis revealed that LGE was a significant predictor of the primary (p=0.003) (Fig.1) and secondary (p=0.001) EPs. Cox regression analysis showed that presence of LGE was associated with an increase in composite primary and secondary EPs (HR: 2.73, p=0.005 and HR: 2.77, p=0.002, respectively). Multivariate analysis showed that LGE was the only independent predictor of both EPs. Conclusions: In patients with known or suspected HF, the presence of LGE is an independent prognostic marker of adverse events, with incremental value to standard clinical information.
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