title: Myocardial damage detected by late gadolinium enhancement cardiovascular magnetic resonance is associated with subsequent hospitalization for heart failure.
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).
  
  
  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.
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Wong
authors.forename: Kayla M
authors.initials: KM
authors.lastname: Piehler
authors.forename: Karolina M
authors.initials: KM
authors.lastname: Zareba
authors.forename: Kathie
authors.initials: K
authors.lastname: Lin
authors.forename: Ashley
authors.initials: A
authors.lastname: Phrampus
authors.forename: Agam
authors.initials: A
authors.lastname: Patel
authors.forename: James C
authors.initials: JC
authors.lastname: Moon
authors.forename: Martin
authors.initials: M
authors.lastname: Ugander
authors.forename: Uma
authors.initials: U
authors.lastname: Valeti
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Holtz
authors.forename: Bo
authors.initials: B
authors.lastname: Fu
authors.forename: Chung-Chou H
authors.initials: CC
authors.lastname: Chang
authors.forename: Michael
authors.initials: M
authors.lastname: Mathier
authors.forename: Peter
authors.initials: P
authors.lastname: Kellman
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Erik B
authors.initials: EB
authors.lastname: Schelbert
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D005682:Gadolinium; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006571:Heterocyclic Compounds; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium
keywords: late gadolinium enhancement; magnetic resonance imaging; myocardial delayed enhancement; myocardial fibrosis; myocardial infarction