Presence of myocardial fibrosis on cardiac MRI and its impact on short-term outcomes in an Asian cohort of heart failure with preserved ejection fraction (HFpEF)

Abstract

Backgrounds and objectives: This study aims to evaluate the presence and prognostic significance of myocardial fibrosis in subjects with and without HFpEF, using Cardiac MRI.

Methods: This was an ambidirectional observational study [mean follow-up: 25 months], selecting HFpEF patients and comparing them with an age and sex-matched control arm without HF. Late gadolinium-enhanced (LGE) imaging and T1 mapping were used to assess fibrosis.

Results: LGE (27 % vs 0 %, p = 0.005) and mid-segment (1062 ± 64 ms vs 1020±8 ms, p < 0.001) or total average (1057 ± 70 ms vs 1020±4 ms, p = 0.006) T1 values were significantly higher in HFpEF group (N = 30) compared to the control group. However, there was no significant difference in T2 values (p = 0.657). 53.3 % of our patients with HFpEF had a clinical event (HF hospitalization, stroke or all-cause mortality) during the follow-up. It was found that average mid-segment (1099 ± 67 ms vs 1019 ± 17 ms, p<0.001) and total average (1101 ± 70 ms vs 1007 ± 15 ms, p<0.001) T1 values were significantly higher in the event group compared to the no-event group. There were no differences in LGE prevalence between event and no-event groups. However, LGE negative cases had significantly increased T1 values in all segments compared to the healthy control group (p<0.001).

Conclusions: Higher T1 values but not T2 values , were associated with the HFpEF group compared to the age and sex-matched control group. Focal fibrosis, as evident by LGE, was significantly more in HFpEF. Among HFpEF patients, high T1 myocardial values were associated with a higher rate of all-cause death, stroke, and HF hospitalization in short-term follow-up.

Keywords: Asian; HFpEF; Heart failure; Magnetic resonance imaging; T1.