Myocardial Damage Detected by Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Is Associated With Subsequent Hospitalization for Heart Failure

• Type of Material: Article
• Authors: Timothy C. Wong, University of Pittsburgh; Kayla M. Piehler, University of Pittsburgh; Karolina M. Zareba, University of Pittsburgh; Kathie Lin, University of Pittsburgh; Ashley Phrampus, University of Pittsburgh; Agam Patel, University of Pittsburgh; James C. Moon, University College London; Martin Ugander, Karolinska Institutet; Uma Valeti, University of Minnesota; Jonathan E. Holtz, University of Pittsburgh; Bo Fu, University of Pittsburgh; Chung-Chou H. Chang, University of Pittsburgh; Michael Mathier, University of Pittsburgh; Peter Kellman, National Heart, Lung, and Blood Institute; Javed Butler, Emory University; Mihai Gheorghiade, Northwestern University; Erik B. Schelbert, University of Pittsburgh
• Language: English
• Date: 2013-12-01
• Publisher: Wiley Open Access
• Publication Version: Final Published Version
• Copyright Statement: © 2013 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
• License: Creative Commons Attribution-Noncommercial 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.113.000416
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 2
• Issue: 6
• Start Page: e000416
• End Page: e000416
• Grant/Funding Information: This work was also supported by grant UL1 RR024153 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), NIH Roadmap for Medical Research.; Dr Moon is supported by the UK National Institute for Health Research University College London Hospitals Biomedical Research Centre.; Dr Schelbert is supported by a grant from The Pittsburgh Foundation, Grant M2009-0068, and an American Heart Association Scientist Development grant (09SDG2180083) including a T. Franklin Williams Scholarship Award; funding provided by: Atlantic Philanthropies, Inc, the John A. Hartford Foundation, the Association of Specialty Professors, and the American Heart Association.; Dr Wong is supported by grant K12 HS19461-01 from the Agency for Healthcare Research and Quality.
• Keywords: MULTICENTER; QUANTIFICATION; magnetic resonance imaging; DYSFUNCTION; myocardial fibrosis; EJECTION FRACTION; OUTCOMES; CONTRAST; Cardiac & Cardiovascular Systems; DILATED CARDIOMYOPATHY; PERFORMANCE; myocardial delayed enhancement; myocardial infarction; Life Sciences & Biomedicine; Cardiovascular System & Cardiology; late gadolinium enhancement; RISK PREDICTION; Science & Technology; PREVALENCE
• Research Categories: Biology, Physiology; Health Sciences, Medicine and Surgery; Biology, Biostatistics

Abstract

BACKGROUND: Hospitalization for heart failure (HHF) is among the most important problems confronting medicine. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) robustly identifies intrinsic myocardial damage. LGE may indicate inherent vulnerability to HHF, regardless of etiology, across the spectrum of heart failure stage or left ventricular ejection fraction (LVEF). METHODS AND RESULTS: We enrolled 1068 consecutive patients referred for CMR where 448 (42%) exhibited LGE. After a median of 1.4 years (Q1 to Q3: 0.9 to 2.0 years), 57 HHF events occurred, 15 deaths followed HHF, and 43 deaths occurred without antecedent HHF (58 total deaths). Using multivariable Cox regression adjusting for LVEF, heart failure stage, and other covariates, LGE was associated with first HHF after CMR (HR: 2.70, 95% CI: 1.32 to 5.50), death (HR: 2.13, 95% CI: 1.08 to 4.21), or either death or HHF (HR: 2.52, 95% CI: 1.49 to 4.25). Quantifying LGE extent yielded similar results; more LGE equated higher risks. LGE improved model discrimination (IDI: 0.016, 95% CI: 0.005 to 0.028, P=0.002) and reclassification of individuals at risk (continuous NRI: 0.40, 95% CI: 0.05 to 0.70, P=0.024). Adjustment for competing risks of death that shares common risk factors with HHF strengthened the LGE and HHF association (HR: 4.85, 95% CI: 1.40 to 16.9). CONCLUSIONS: The presence and extent of LGE is associated with vulnerability for HHF, including higher risks of HHF across the spectrum of heart failure stage and LVEF. Even when LVEF is severely decreased, those without LGE appear to fare reasonably well. LGE may enhance risk stratification for HHF and may enhance both clinical and research efforts to reduce HHF through targeted treatment.