P2445Cardiovascular magnetic resonance imaging in acute decompensated heart failure with reduced ejection fraction

Abstract

Background: Heart failure is a complex clinical syndrome with growing prevalence and substantial impact on health care in the western world. Furthermore, mortality is enormous in these patients. Heart failure with reduced ejection fraction (HFrEF) may result from a variety of causes and delayed enhancement cardiovascular magnetic resonance imaging (DE-CMR) seems ideal to define the etiology thereof. A head to head, real-world comparison of clinical parameters, biomarkers and DE-CMR in this population has not yet been performed. Purpose: To evaluate the capability of DE-CMR compared to clinical parameters and biomarkers in acute decompensated HFrEF to define the etiology of heart failure. Methods: Consecutive patients hospitalized with acute decompensated heart failure and newly diagnosed reduced left ventricular function by echocardiography (EF≤45%) were included. Patients presenting with an acute coronary syndrome (ACS), preserved ejection fraction or contraindications to DE-CMR were excluded. All patients underwent DE-CMR within the index hospitalization. Results: 339 consecutive patients were included (mean age 60±15 years, 62% male gender) in this study, whereof 241 patients (71%) experienced symptoms within 30 days prior to hospitalization. 166 (49%) patients presented with an EF between 30 and 45%, whereas 173 patients (51%) showed an EF of less than 30%. Despite excluding patients with an ACS a priori, DE-CMR detected silent myocardial infarction in 61 patients (18%). There was no statistical difference between ischemic and non-ischemic cardiomyopathies in EF, clinical parameters and biomarkers. Flu-like symptoms were more common in non-ischemic heart failure patients (p<0.05). Conclusion:In patients with acute decompensated heart failure and reduced ejection fraction, clinical parameters and biomarkers do not differentiate nonischemic and ischemic causes of heart failure. Contrary, DE-CMR allows for accurate differentiaton thereof and further refining the etiology of heart failure. Thus,CMR facilitates patient management and impacts prognosis in the individual patient in a real-world setting. worse clinical outcomes in subjects with ischemic cardiomyopathy after resynchronization treatment. P2446 | BEDSIDE