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Cardiac magnetic resonance in patients with mid-range ejection fraction: prognosis implications.

Session Poster session 1

Speaker Marina Pascual Izco

Congress : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Systolic and Diastolic Function
  • Session type : Poster Session
  • FP Number : P154

Authors : M Pascual Izco (Madrid,ES), R Hinojar Baydes (Madrid,ES), A Lorente Ros (Madrid,ES), GL Alonso Salinas (Madrid,ES), MA Fernandez Mendez (Madrid,ES), M Plaza Martin (Madrid,ES), A Garcia De Vicente (Madrid,ES), S Del Prado Diaz (Madrid,ES), M Abellas Sequeiros (Madrid,ES), A Garcia Martin (Madrid,ES), A Gonzalez Gomez (Madrid,ES), E Gonzalez Ferrer (Madrid,ES), JL Zamorano Gomez (Madrid,ES), C Fernandez-Golfin Loban (Madrid,ES)

Authors:
M Pascual Izco1 , R Hinojar Baydes1 , A Lorente Ros1 , GL Alonso Salinas1 , MA Fernandez Mendez2 , M Plaza Martin1 , A Garcia De Vicente2 , S Del Prado Diaz1 , M Abellas Sequeiros1 , A Garcia Martin1 , A Gonzalez Gomez1 , E Gonzalez Ferrer1 , JL Zamorano Gomez1 , C Fernandez-Golfin Loban1 , 1Ramón y Cajal University Hospital, Cardiology - Madrid - Spain , 2Ramón y Cajal University Hospital, Radiology - Madrid - Spain ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii106

Background: According to European Guidelines, a new entity of Heart Failure (HF) has been described: Mid-range ejection fraction (mrEF). However, mrEF patient characteristics are poorly defined. Cardiac magnetic resonance (CMR) is crucial in the study of cardiomyopathies. So, the aim of this study was to establish the long-term prognostic value of several CMR parameters in mrEF patients.
Methods: 132 patients with mrEF underwent a CMR study between 2012-2018 using a 1,5 T scanner with SSFP and double inversion recovery delayed enhacement images performed after contrast administration. Clinical parameters were recorded after a median follow-up of 762 (230-1315) days. Primary combined endpoint included all-cause death and HF decompensation. Secondary endpoints were NYHA Class, diuretic use and BNP levels. Patients with other cardiac affection rather than mrEF were excluded.
Results: Mean age was 59±12.1 years, 76% were male. Etiology was mostly ischemic (46%), followed by idiopathic (21%) and others (32%). Table 1 shows results for primary endpoint. NYHA Class results are shown on Figure 1. During follow-up, 18% (n=23) were under diuretic treatment. These patients presented higher indexed left atrium volume (LAV) (60.8±5.40ml/m2 vs 49.0±12.0ml/m2, p=0.02) and higher indexed right ventricle end dyastolic volume (IRVEDV) (73.5±6.4ml/m2 vs 64.6±1.6ml/m2, p=0.05). Patients with higher IRVEDV presented a significant correlation with BNP levels (0.55, p<0.01).
Conclusions: mrEF is not a benign condition. CMR higher right ventricle (RV) volumes and less RV EF as well as higher LAV seem to be associated with worse prognosis and may be used in clinical practice to better stratify these patients.

Primary Endpoint: Combined all-cause Death or HF decompensation

CMR parameters

YES (n=18, 14%)

NO (n=114, 86%)

p

ILVEDV (ml/m2)

82.57±5.53

92.48±1.97

0.07

ILVESV (ml/m2)

45.67±3.18

52.09±1.25

0.06

IND LV mass (g/m2)

57.83±4.74

63.69±1.50

0.19

LVEF (%) 44.80±0.59 44.69±0.25 0.87

IND LAV (ml/m2)

53.67±6.12

50.53±1.95

0.60

LGE (%)

9 (64.29%)

73 (69.52%)

0.69

RVEF (%)

56.92±3.29

61.54±0.77

0.05

IRVEDV (ml/m2)

71.47±8.20

65.10±1.46

0.19

IRVESV (ml/m2)

33.21±5.73

25.58±0.95

0.02

HF: Heart Failure; CMR: Cardiac Magnetic Resonance; ILVEVD: Indexed Left Ventricle End Diastolic Volume; ILVESV: Indexed Left Ventricle End Systolic Volume; ILV mass: Indexed Left Ventricle mass; LVEF: Left Ventricle Ejection Fraction; IND LAV: Indexed left atrium volume; LGE: late gadolinium enhancement; RVEF: Right Ventricle Ejection Fraction; IRVEDV: Indexed Right Ventricle End Diastolic Volume; IRVESV: Indexed Right Ventricle End Systolic Volume.



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