Zhang Xiaojie, Yang Shaomin, Hao Shali, Li Jiahuan, Qiu Min, Chen Haixiong, Huang Yuli
Department of Cardiology, Shunde Hospital, Southern Medical University (the First People's Hospital of Shunde), Jiazhi Road, Lunjiao Town, Shunde District, Foshan, 528300, China.
Department of Radiology, Lecong Hospital of Shunde, Foshan, China.
Eur Radiol. 2024 Mar;34(3):1854-1862. doi: 10.1007/s00330-023-10218-w. Epub 2023 Sep 2.
Heart failure with preserved ejection fraction (HFpEF) is a syndrome with significant clinical heterogeneity. Myocardial fibrosis has been considered a common pathological process in the development and progress of HFpEF. This study aimed to consolidate data on the prognostic effect of myocardial fibrosis, evaluated by cardiovascular magnetic resonance (CMR) imaging in patients with HFpEF.
Three medical databases were searched for potentially related articles up to February 28, 2023. Cohort studies reporting associations between myocardial fibrosis and risk of all-cause mortality or composite major adverse cardiac outcomes (MACE) were included. Cardiac fibrosis was evaluated by CMR metrics, including late gadolinium enhancement (LGE) or myocardial extracellular volume (ECV). The hazard ratios (HRs) and 95% confidence intervals (CI) of the outcomes for higher myocardial fibrosis were calculated.
Twelve studies with 2787 patients with HFpEF were included for analysis. After a median follow-up duration of 31.2 months, a higher level of cardiac fibrosis was associated with a significant increase in the risk of MACE (HR = 1.34, 95% CI = 1.14-1.57) and all-cause mortality (HR = 1.74, 95% CI = 1.27-2.39), respectively. Furthermore, the increased risk of outcomes was both observed when cardiac fibrosis was defined according to LGE or ECV, respectively.
Higher burden of myocardial fibrosis evaluated by CMR can predict a poor prognosis in patients with HFpEF. Evaluation of LGE or ECV based on CMR could be recommended in these patients for risk stratification and guiding further treatment.
Inclusion of cardiovascular magnetic resonance examination in the diagnostic and risk-evaluation algorithms in patients with heart failure with preserved ejection fraction should be considered in clinical practice and future studies.
• Myocardial fibrosis is a common pathological process in heart failure with preserved ejection fraction. • A higher myocardial fibrosis burden on cardiac magnetic resonance predicts a poor prognosis in patients with heart failure with preserved ejection fraction. • Evaluation of myocardial fibrosis may be useful in patients with heart failure with preserved ejection fraction for risk stratification and treatment guidance.
射血分数保留的心力衰竭（HFpEF）是一种具有显著临床异质性的综合征。心肌纤维化被认为是HFpEF发生发展过程中的一个常见病理过程。本研究旨在汇总通过心血管磁共振（CMR）成像评估的心肌纤维化对HFpEF患者预后影响的数据。
检索了三个医学数据库，以查找截至2023年2月28日的潜在相关文章。纳入报告心肌纤维化与全因死亡率或复合主要不良心脏事件（MACE）风险之间关联的队列研究。通过CMR指标评估心脏纤维化，包括延迟钆增强（LGE）或心肌细胞外容积（ECV）。计算心肌纤维化程度较高时结局的风险比（HR）和95%置信区间（CI）。
纳入12项研究，共2787例HFpEF患者进行分析。中位随访时间为31.2个月后，较高程度的心脏纤维化分别与MACE风险（HR = 1.34，95%CI = 1.14 - 1.57）和全因死亡率（HR = 1.74，95%CI = 1.27 - 2.39）的显著增加相关。此外，分别根据LGE或ECV定义心脏纤维化时，均观察到结局风险增加。
通过CMR评估的较高心肌纤维化负担可预测HFpEF患者预后不良。对于这些患者，建议基于CMR评估LGE或ECV，以进行风险分层并指导进一步治疗。
在临床实践和未来研究中，应考虑将心血管磁共振检查纳入射血分数保留的心力衰竭患者的诊断和风险评估算法中。
• 心肌纤维化是射血分数保留的心力衰竭中的常见病理过程。• 心脏磁共振上较高的心肌纤维化负担预示射血分数保留的心力衰竭患者预后不良。• 评估心肌纤维化可能有助于射血分数保留的心力衰竭患者进行风险分层和治疗指导。
