In patients with new-onset HF and LVSD for whom there are no clinical and exploratory data suggestive of ischaemic heart disease, CMR with LGE is an excellent means of ruling out significant CAD and is a valid alternative to angiography.
BackgroundPulmonary hypertension is associated with poor prognosis in heart failure.
However, non-invasive diagnosis is still challenging in clinical
practice.ObjectiveWe sought to assess the prognostic utility of non-invasive estimation of
pulmonary vascular resistances (PVR) by cardiovascular magnetic resonance to
predict adverse cardiovascular outcomes in heart failure with reduced
ejection fraction (HFrEF).MethodsProspective registry of patients with left ventricular ejection fraction
(LVEF) < 40% and recently admitted for decompensated heart failure during
three years. PVRwere calculated based on right ventricular ejection fraction
and average velocity of the pulmonary artery estimated during cardiac
magnetic resonance. Readmission for heart failure and all-cause mortality
were considered as adverse events at follow-up.Results105 patients (average LVEF 26.0 ±7.7%, ischemic etiology 43%) were
included. Patients with adverse events at long-term follow-up had higher
values of PVR (6.93 ± 1.9 vs. 4.6 ± 1.7estimated Wood Units
(eWu), p < 0.001). In multivariate Cox regression analysis, PVR ≥
5 eWu(cutoff value according to ROC curve) was independently associated with
increased risk of adverse events at 9 months follow-up (HR2.98; 95% CI
1.12-7.88; p < 0.03).ConclusionsIn patients with HFrEF, the presence of PVR ≥ 5.0 Wu is associated
with significantly worse clinical outcome at follow-up. Non-invasive
estimation of PVR by cardiac magnetic resonance might be useful for risk
stratification in HFrEF, irrespective of etiology, presence of late
gadolinium enhancement or LVEF.
Background
Pulmonary hypertension (PH) conveys a worse prognosis in heart failure (HF), in particular when right ventricular (RV) dysfunction ensues. Cardiovascular magnetic resonance (CMR) non-invasively estimates pulmonary vascular resistance (PVR), which has shown prognostic value in HF. Importantly, RV to pulmonary artery (PA) coupling is altered early in HF, before significant rise in PV resistance occurs. The aim of this study was to assess the prognostic value of mean velocity at the pulmonary artery (mvPA), a novel non-invasive parameter determined by CMR, in HF with reduced ejection fraction (HFrEF) with and without associated PH.
Methods
Prospective inclusion of 238 patients admitted for new-onset HFrEF. MvPA was measured with CMR during index admission. The primary endpoint was defined as a composite of HF readmissions and all-cause mortality.
Results
During a median follow-up of 25 months, 91 patients presented with the primary endpoint. Optimal cut-off value of mvPA calculated by the receiver operator curve for the prediction of the primary endpoint was 9 cm/s. The primary endpoint occurred more frequently in patients with mvPA≤9 cm/s, as indicated by Kaplan-Meier survival curves; Log Rank 16.0, p < 0.001. Importantly, mvPA maintained its prognostic value regardless of RV function and also when considering mortality and HF readmissions separately. On Cox proportional hazard analysis, reduced mvPA≤9 cm/s emerged as an independent prognostic marker, together with NYHA III-IV/IV class, stage 3–4 renal failure and ischemic cardiomyopathy.
Conclusions
In our HFrEF cohort, mvPA emerged as an independent prognostic indicator independent of RV function, allowing identification of a higher-risk population before structural damage onset. Moreover, mvPA emerged as a surrogate marker of the RV-PA unit coupling status.
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