TOPLINE

In patients with heart failure and mildly reduced ejection fraction (HFmrEF), the extent of late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) along with a related measure of tissue damage predicted the risk for sudden cardiac death (SCD)-related events.

METHODOLOGY

• Researchers conducted a multicenter retrospective observational study to assess whether CMR-derived LGE and T1 mapping improved risk stratification for SCD in patients with HFmrEF.
• They included patients with HFmrEF from five tertiary hospitals in China between 2015 and 2025. A total of 1417 patients were included in the development cohort (mean age, 55.8 years; 64.2% men), and 438 in the validation cohort (mean age, 53.4 years; 62.1% men).
• All patients underwent echocardiography and CMR, including LGE imaging and T1 mapping, and extracellular volume (indicating tissue damage) was calculated.
• The primary endpoint was a composite of SCD-related events. Secondary endpoints were a composite of heart failure (HF) death, unplanned hospitalization for HF, or cardiac transplantation.
• The median follow-up duration was 42 months for the development cohort and 43 months for the validation cohort.

TAKEAWAY

• LGE extent ≥ 6.3% was independently associated with an increased risk for SCD-related events (adjusted hazard ratio [HR], 5.33; P < .001).
• Extracellular volume ≥ 28.4% was associated with an increased risk for SCD (HR, 3.44; P < .001) and reclassified higher risk among patients with absent or mild LGE.
• A native T1 z-score ≥ 2.7 predicted higher risk for SCD (HR, 2.40; P < .001). Native T1 remained an independent predictor of SCD risk within a model built for patients who could not undergo contrast imaging.
• A risk stratification statistical model combining LGE extent and extracellular volume achieved the best prognostic performance with a C-statistic of 0.79.

IN PRACTICE

"[The] study provides practical solutions for refining SCD risk stratification in HFmrEF, ultimately contributing to improved clinical outcomes in this high-risk patient population," the authors wrote.

SOURCE

The study was led by Wenxian Wang, Shandong Provincial Hospital Affiliated to Shandong First Medical University in Jinan, China. It was published online on August 19 in The Lancet Regional Health: Western Pacific.

LIMITATIONS

Researchers used left ventricular EF measured at hospitalization and did not analyze changes over time. Not all patients underwent coronary angiography to rule out coronary artery disease. The cohort included patients referred for CMR, instead of a random sample.

DISCLOSURES

The study received support from the National Natural Science Foundation of China and the Key R&D Program of Shandong Province, China. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.