title: Prognostic significance of quantitative assessment of focal myocardial fibrosis in patients with heart failure with preserved ejection fraction.
abstract: BACKGROUND
  The aim of this study was to investigate the prognostic value of myocardial focal fibrosis quantified by late gadolinium enhanced (LGE) magnetic resonance imaging (MRI) in patients with heart failure with preserved ejection fraction (HFpEF).
  
  
  METHODS
  One-hundred eleven HFpEF patients (mean age: 70 ± 14 years, 55 (50%) female) were enrolled. We excluded patients with previous history of coronary artery disease and/or ischemic pattern of hyper enhancement on LGE MRI. Myocardial enhancement was defined using signal intensity >2SD above the mean signal intensity of a remote myocardium. Major adverse cardiovascular events were defined as cardiovascular death and heart failure requiring hospitalization.
  
  
  RESULTS
  During a mean follow up period of 851 ± 609 days, 10 events (2 cardiovascular death, 8 hospitalization for heart failure decompensation) were observed. Area under the receiver operating characteristics curve of LGE% for the detection of future events was 0.721 (95% CI: 0.628-0.802). Multivariate Cox proportional hazard analysis showed that LGE% is an independent predictor of future events after the adjustment with prognostic 5 factors - age, diabetes mellitus, New York Heart Association classification, history of heart failure hospitalization and left ventricular ejection fraction - which were identified in the I-PRESERVE study (Irbesartan in Heart Failure with Preserved Ejection Fraction Study) (hazard ratio=7.913, 95% CI: 1.603-39.05, P=0.012).
  
  
  CONCLUSIONS
  Larger size of LGE was significantly associated with high rate of future cardiovascular death and heart failure hospitalization, suggesting that the quantification of myocardial focal fibrosis by LGE MRI could be useful for the risk stratification in HFpEF patients.
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan. Electronic address: shingo.m12226@gmail.com.
authors.forename: Shingo
authors.initials: S
authors.lastname: Kato
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan.
authors.forename: Naka
authors.initials: N
authors.lastname: Saito
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan.
authors.forename: Hidekuni
authors.initials: H
authors.lastname: Kirigaya
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Gyotoku
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Iinuma
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kusakawa
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Iguchi
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakachi
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Fukui
authors.affiliation: Department Radiology, Kanagawa Cardiovascular and Respiratory Center, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Futaki
authors.affiliation: Department Radiology, Kanagawa Cardiovascular and Respiratory Center, Japan.
authors.forename: Tae
authors.initials: T
authors.lastname: Iwasawa
authors.affiliation: Department of Biostatistics and Epidemiology, Yokohama City University, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Taguri
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University Hospital, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005355:Fibrosis / Q000175:diagnosis / Q000378:metabolism; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000378:metabolism; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology
keywords: HFpEF; Heart failure; LGE MRI; Prognostic value