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Diffuse myocardial fibrosis and the prognosis of heart failure with reduced ejection fraction in Chinese patients: a cohort study

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Abstract

Evidence regarding the relationship between diffuse myocardial fibrosis and the prognosis of heart failure with reduced ejection fraction (HFrEF) was limited. Therefore, this study set out to investigate whether diffuse myocardial fibrosis was independently related to the prognosis of failure with reduced ejection fraction in Chinese patients after adjusting for other covariates. The present study was a cohort study. A total of 45 consecutive HFrEF patients were involved in Zhongshan Hospital of Fudan University in China from 1/9/2015 to 31/12/2016. The target-independent variable was extracellular volume (ECV) quantified by cardiac magnetic resonance T1 mapping using the modified Look-Locker inversion recovery (MOLLI) sequence at baseline. To assess the prognostic impact of MOLLI–ECV, its association with hospitalization for heart failure/cardiac death was tested by multivariable Cox regression analysis. Covariates involved in this study included age, gender, body mass index, heart rate, systolic blood pressure diastolic blood pressure, smoking, hypertension, diabetes mellitus, etiology, NYHA functional class, blood urea nitrogen, creatinine, serum uric acid, total bilirubin, and growth stimulation-expressed gene 2. Ten age- and sex-matched healthy participants with no history of cardiovascular disease served as a control group. Mean MOLLI–ECV was significantly higher in HFrEF patients versus healthy controls (29.55 ± 1.46% vs. 23.17 ± 1.93%, P < 0.001). Patients were followed for 9 months, during which the primary outcome (cardiac death or first heart failure hospitalization) occurred in 15 patients. By Kaplan–Meier analysis, patients with high MOLLI–ECV ≥ 30.10% had shorter event-free survival than the middle (MOLLI–ECV between 30.10 and 28.60) and low (MOLLI–ECV < 28.60) MOLLI–ECV patients (log-rank, P = 0.0035). Result of fully-adjusted multivariable Cox regression analysis showed MOLLI–ECV was positively associated with the composite outcome of HFrEF patients after adjusting confounders hazard ratio (HR) 2.57, 95% CI (1.09, 6.04). By subgroup analysis, a stronger association was seen in patients who with NYHA functional class III–IV, hematocrit < 39.8%, left atrial diameter ≥ 53.5 mm, or without the medical history of MRA or diuretics other than MRA. The P for interaction was < 0.05. In HFrEF patients, the relationship between MOLLI–ECV determined by CMR and the composite outcome is linear. High MOLLI–ECV was associated with a higher rate of cardiac mortality and first HF hospitalization in the short term follow up.

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Abbreviations

HFrEF:

Heart failure with reduced ejection fraction

HFpEF:

Heart failure with preserved ejection fraction

ECV:

Extracellular volume

MOLLI:

Modified look-locker inversion recovery

NYHA:

New york heart association

HR:

Hazard ratio

MRA:

Mineralocorticoid receptor antagonism

HF:

Heart failure

LV:

Left ventricle

CMR:

Cardiovascular magnetic resonance

LGE:

Late gadolinium enhancement

NT-proBNP:

N-terminal prohormone of brain natriuretic peptide

LVEF:

Left ventricular ejection fraction

ECG:

Electrocardiogram

bSSFP:

Balanced steady-state free precession sequence

BMI:

Body mass index

PINP:

N-terminal propeptide of type I procollagen

PIIINP:

N-terminal propeptide of type III procollagen

PICP:

Type I procollagen carboxyterminal propeptide

CI:

Confidence interval

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Acknowledgements

This study was supported by grants from the Program for the Outstanding Academic Leaders supported by Shanghai Science and Technology Commission (Grant No. 16XD1400700), National Natural Science Foundation of China (Grant No. 81370199),and National Basic Research Program of China (973 350 Program, 2012CB518605).

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Author notes

  1. Fuhai Li and Mengying Xu have contributed equally to this study.

Authors and Affiliations

  1. Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Fuhai Li, Mengying Xu, Yanyan Wang, Yu Song, Xiaotong Cui, Mingqiang Fu, Baozheng Qi, Xueting Han, Jingmin Zhou & Junbo Ge

  2. Department of Cardiology, Shanghai Xuhui Central Hospital, Shanghai, 200032, China

    Yuyuan Fan

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  1. Fuhai Li
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  2. Mengying Xu
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  5. Yu Song
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  10. Jingmin Zhou
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Correspondence to Jingmin Zhou or Junbo Ge.

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Li, F., Xu, M., Fan, Y. et al. Diffuse myocardial fibrosis and the prognosis of heart failure with reduced ejection fraction in Chinese patients: a cohort study. Int J Cardiovasc Imaging 36, 671–689 (2020). https://doi.org/10.1007/s10554-019-01752-0

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  • DOI: https://doi.org/10.1007/s10554-019-01752-0

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