Myocardial fibrosis and prognosis in heart failure with preserved ejection fraction: a pooled analysis of 12 cohort studies
Objectives 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 my...
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| Veröffentlicht in: | European radiology 2024-03, Vol.34 (3), p.1854-1862 |
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| creator | Zhang, Xiaojie Yang, Shaomin Hao, Shali Li, Jiahuan Qiu, Min Chen, Haixiong Huang, Yuli |
| description | Objectives
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.
Methods
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.
Results
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.
Conclusions
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.
Clinical relevance statement
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.
Key Points
• 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. |
| doi_str_mv | 10.1007/s00330-023-10218-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2860616360</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2860616360</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-d3ec2c899e06a479638d606705dd266ec2a4b9f5e001f0e3050204b9f9ffe58e3</originalsourceid><addsrcrecordid>eNp9kU9vEzEQxS1ERULgC3BAlrhwWTq2d20vN1TxT0rVSzlbznrcONqsg71LFPHl6yQFKg49ecbvN88aP0LeMPjAANRlBhACKuCiYsCZrvbPyJzVgpdW188f1TPyMucNALSsVi_ITCjZaN3KOfl9fYidTS7YnvqwSjGHTO3g6C7Fu-HUhYGu0aaRehv6KSHdh3FddMyYfqGjuMFuDHGgPtlT8ZFauouxL5odbH84mkRPGaddXMdilMfJBcyvyIW3fcbXD-eC_Pjy-fbqW7W8-fr96tOy6oRqxsoJ7Hin2xZB2lq1UmgnQSponONSFtHWq9Y3CMA8oIAGOBxvWu-x0SgW5P3Zt-z0c8I8mm3IHfa9HTBO2XBd7JgUEgr67j90E6dUlihUy5USWoEsFD9TXfmvnNCbXQpbmw6GgTlGY87RmBKNOUVj9mXo7YP1tNqi-zvyJ4sCiDOQizTcYfr39hO297bFmtQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2927738706</pqid></control><display><type>article</type><title>Myocardial fibrosis and prognosis in heart failure with preserved ejection fraction: a pooled analysis of 12 cohort studies</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Zhang, Xiaojie ; Yang, Shaomin ; Hao, Shali ; Li, Jiahuan ; Qiu, Min ; Chen, Haixiong ; Huang, Yuli</creator><creatorcontrib>Zhang, Xiaojie ; Yang, Shaomin ; Hao, Shali ; Li, Jiahuan ; Qiu, Min ; Chen, Haixiong ; Huang, Yuli</creatorcontrib><description>Objectives
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.
Methods
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.
Results
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.
Conclusions
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.
Clinical relevance statement
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.
Key Points
• 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.</description><identifier>ISSN: 1432-1084</identifier><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-023-10218-w</identifier><identifier>PMID: 37658896</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Algorithms ; Cardiac ; Cardiomyopathies - diagnosis ; Cohort analysis ; Cohort Studies ; Congestive heart failure ; Contrast Media ; Diagnostic Radiology ; Ejection fraction ; Fibrosis ; Gadolinium ; Health services ; Heart failure ; Heart Failure - diagnosis ; Heterogeneity ; Humans ; Imaging ; Internal Medicine ; Interventional Radiology ; Magnetic resonance ; Magnetic resonance imaging ; Magnetic Resonance Imaging, Cine - methods ; Medical prognosis ; Medicine ; Medicine & Public Health ; Mortality ; Neuroradiology ; Patients ; Predictive Value of Tests ; Prognosis ; Radiology ; Risk assessment ; Stroke Volume ; Ultrasound ; Ventricular Function, Left</subject><ispartof>European radiology, 2024-03, Vol.34 (3), p.1854-1862</ispartof><rights>The Author(s), under exclusive licence to European Society of Radiology 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to European Society of Radiology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-d3ec2c899e06a479638d606705dd266ec2a4b9f5e001f0e3050204b9f9ffe58e3</citedby><cites>FETCH-LOGICAL-c375t-d3ec2c899e06a479638d606705dd266ec2a4b9f5e001f0e3050204b9f9ffe58e3</cites><orcidid>0000-0001-5423-5487</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-023-10218-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-023-10218-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37658896$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhang, Xiaojie</creatorcontrib><creatorcontrib>Yang, Shaomin</creatorcontrib><creatorcontrib>Hao, Shali</creatorcontrib><creatorcontrib>Li, Jiahuan</creatorcontrib><creatorcontrib>Qiu, Min</creatorcontrib><creatorcontrib>Chen, Haixiong</creatorcontrib><creatorcontrib>Huang, Yuli</creatorcontrib><title>Myocardial fibrosis and prognosis in heart failure with preserved ejection fraction: a pooled analysis of 12 cohort studies</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>Objectives
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.
Methods
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.
Results
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.
Conclusions
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.
Clinical relevance statement
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.
Key Points
• 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.</description><subject>Algorithms</subject><subject>Cardiac</subject><subject>Cardiomyopathies - diagnosis</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Congestive heart failure</subject><subject>Contrast Media</subject><subject>Diagnostic Radiology</subject><subject>Ejection fraction</subject><subject>Fibrosis</subject><subject>Gadolinium</subject><subject>Health services</subject><subject>Heart failure</subject><subject>Heart Failure - diagnosis</subject><subject>Heterogeneity</subject><subject>Humans</subject><subject>Imaging</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Magnetic resonance</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging, Cine - methods</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Neuroradiology</subject><subject>Patients</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Radiology</subject><subject>Risk assessment</subject><subject>Stroke Volume</subject><subject>Ultrasound</subject><subject>Ventricular Function, Left</subject><issn>1432-1084</issn><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9vEzEQxS1ERULgC3BAlrhwWTq2d20vN1TxT0rVSzlbznrcONqsg71LFPHl6yQFKg49ecbvN88aP0LeMPjAANRlBhACKuCiYsCZrvbPyJzVgpdW188f1TPyMucNALSsVi_ITCjZaN3KOfl9fYidTS7YnvqwSjGHTO3g6C7Fu-HUhYGu0aaRehv6KSHdh3FddMyYfqGjuMFuDHGgPtlT8ZFauouxL5odbH84mkRPGaddXMdilMfJBcyvyIW3fcbXD-eC_Pjy-fbqW7W8-fr96tOy6oRqxsoJ7Hin2xZB2lq1UmgnQSponONSFtHWq9Y3CMA8oIAGOBxvWu-x0SgW5P3Zt-z0c8I8mm3IHfa9HTBO2XBd7JgUEgr67j90E6dUlihUy5USWoEsFD9TXfmvnNCbXQpbmw6GgTlGY87RmBKNOUVj9mXo7YP1tNqi-zvyJ4sCiDOQizTcYfr39hO297bFmtQ</recordid><startdate>20240301</startdate><enddate>20240301</enddate><creator>Zhang, Xiaojie</creator><creator>Yang, Shaomin</creator><creator>Hao, Shali</creator><creator>Li, Jiahuan</creator><creator>Qiu, Min</creator><creator>Chen, Haixiong</creator><creator>Huang, Yuli</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5423-5487</orcidid></search><sort><creationdate>20240301</creationdate><title>Myocardial fibrosis and prognosis in heart failure with preserved ejection fraction: a pooled analysis of 12 cohort studies</title><author>Zhang, Xiaojie ; Yang, Shaomin ; Hao, Shali ; Li, Jiahuan ; Qiu, Min ; Chen, Haixiong ; Huang, Yuli</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-d3ec2c899e06a479638d606705dd266ec2a4b9f5e001f0e3050204b9f9ffe58e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Algorithms</topic><topic>Cardiac</topic><topic>Cardiomyopathies - diagnosis</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Congestive heart failure</topic><topic>Contrast Media</topic><topic>Diagnostic Radiology</topic><topic>Ejection fraction</topic><topic>Fibrosis</topic><topic>Gadolinium</topic><topic>Health services</topic><topic>Heart failure</topic><topic>Heart Failure - diagnosis</topic><topic>Heterogeneity</topic><topic>Humans</topic><topic>Imaging</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Magnetic resonance</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging, Cine - methods</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Neuroradiology</topic><topic>Patients</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Radiology</topic><topic>Risk assessment</topic><topic>Stroke Volume</topic><topic>Ultrasound</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhang, Xiaojie</creatorcontrib><creatorcontrib>Yang, Shaomin</creatorcontrib><creatorcontrib>Hao, Shali</creatorcontrib><creatorcontrib>Li, Jiahuan</creatorcontrib><creatorcontrib>Qiu, Min</creatorcontrib><creatorcontrib>Chen, Haixiong</creatorcontrib><creatorcontrib>Huang, Yuli</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhang, Xiaojie</au><au>Yang, Shaomin</au><au>Hao, Shali</au><au>Li, Jiahuan</au><au>Qiu, Min</au><au>Chen, Haixiong</au><au>Huang, Yuli</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Myocardial fibrosis and prognosis in heart failure with preserved ejection fraction: a pooled analysis of 12 cohort studies</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2024-03-01</date><risdate>2024</risdate><volume>34</volume><issue>3</issue><spage>1854</spage><epage>1862</epage><pages>1854-1862</pages><issn>1432-1084</issn><issn>0938-7994</issn><eissn>1432-1084</eissn><abstract>Objectives
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.
Methods
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.
Results
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.
Conclusions
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.
Clinical relevance statement
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.
Key Points
• 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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37658896</pmid><doi>10.1007/s00330-023-10218-w</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-5423-5487</orcidid></addata></record> |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Algorithms Cardiac Cardiomyopathies - diagnosis Cohort analysis Cohort Studies Congestive heart failure Contrast Media Diagnostic Radiology Ejection fraction Fibrosis Gadolinium Health services Heart failure Heart Failure - diagnosis Heterogeneity Humans Imaging Internal Medicine Interventional Radiology Magnetic resonance Magnetic resonance imaging Magnetic Resonance Imaging, Cine - methods Medical prognosis Medicine Medicine & Public Health Mortality Neuroradiology Patients Predictive Value of Tests Prognosis Radiology Risk assessment Stroke Volume Ultrasound Ventricular Function, Left |
| title | Myocardial fibrosis and prognosis in heart failure with preserved ejection fraction: a pooled analysis of 12 cohort studies |
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