Abstract
BackgroundCardiac magnetic resonance imaging (MRI) is emerging as an important imaging tool in the assessment of heart failure with preserved ejection fraction (HFpEF). This systematic review and meta-analysis aim to synthesise and consolidate the current literature on cardiac MRI for prognostication of HFpEF. Methods designSystematic review and meta-analysis. Data sources: Scopus (PubMed and Embase) for studies published between 2008 and 2019. Eligibility criteria for study selection were studies that evaluated the prognostic role of cardiac MRI in HFpEF. Random effects meta-analyses of the reported hazard ratios (HR) for clinical outcomes was performed. ResultsInitial screening identified 97 studies. From these, only nine (9%) studies met all the criteria. The main cardiac MRI methods that demonstrated association to prognosis in HFpEF included late gadolinium enhancement (LGE) assessment of scar (n = 3), tissue characterisation with T1-mapping (n = 4), myocardial ischaemia (n = 1) and right ventricular dysfunction (RVSD) (n = 1). The pooled HR for all 9 studies was 1.52 (95% CI 1.05–1.99, P < 0.01). Sub-evaluation by cardiac MRI methods revealed varying HRs: LGE (net n = 402, HR = 1.6, 95% CI 0.42–2.78, P = 0.008); T1-mapping (n = 1623, HR = 1.25, 95% CI 0.891–1.60, P < 0.001); myocardial ischaemia or RVSD (n = 325, HR = 3.19, 95% CI 0.30–6.08, P = 0.03). ConclusionThis meta-analysis demonstrates that multiparametric cardiac MRI has value in prognostication of patients with HFpEF. HFpEF patients with a detectable scar on LGE, fibrosis on T1-mapping, myocardial ischaemia or RVSD appear to have a worse prognosis. PROSPERO registration numberCRD42020187228.
Highlights
Heart failure with preserved ejection fraction (HFpEF) accounts for over 50% of all heart failure cases [1]
We identified the number of patients involved; the primary cardiac magnetic resonance imaging (MRI) method used; the follow-up period and the clinical outcomes with the hazard ratio for cardiac MRI variables to predict outcomes
More studies are warranted exploring multi-parametric cardiac MRI utility in prognostication of patients with heart failure with preserved ejection fraction (HFpEF). This meta-analysis demonstrates that multiparametric cardiac MRI has value in prognostication of patients with HFpEF
Summary
Heart failure with preserved ejection fraction (HFpEF) accounts for over 50% of all heart failure cases [1]. HFpEF is a clinical syndrome in which the heart is incapable of delivering enough oxygen to the tissues proportionate with their metabolic demands while the contraction is not impaired [2]. It is associated with poor quality of life, significantly more need for medical attention, and a higher risk of premature death [3]. The main cardiac MRI methods that demonstrated association to prognosis in HFpEF included late gadolinium enhancement (LGE) assessment of scar (n = 3), tissue characterisation with T1-mapping (n = 4), myocardial ischaemia (n = 1) and right ventricular dysfunction (RVSD) (n = 1).
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