156 Left atrial dilatation on cardiovascular magnetic resonance imaging predicts adverse outcomes in acute heart failure

Résumé fourni par la source

Introduction Acute hospital admissions due to heart failure account for significant morbidity and mortality. Identifying determinants of adverse outcomes in patients with acute heart failure is vital to ensuring patients are medically optimised and to prevent re-admission. Cardiovascular Magnetic Resonance (CMR) imaging has become a key investigation in patients with heart failure. We sought to determine the utility of CMR in acute heart failure admissions and identify any potential CMR biomarkers, which may be associated with adverse outcomes. Methods We reviewed all acute heart failure admissions to our tertiary centre Heart Failure Unit (HFU) who had an inpatient CMR scan over a 4.5-year period (August 2018 – December 2022). Patient demographics, indication for CMR and scan findings were recorded from electronic patient records. Morbidity and mortality data including major adverse cardiovascular events (MACE) including stroke and arrhythmia were recorded from the patient notes including community patient records. Results 85 patients were included in the study, 75% (64) patients were male, and the mean age was 69±13 years. Primary reason for admission in 80% patients was dyspnoea and peripheral oedema. The majority of patients (78%) had heart failure with a reduced ejection fraction (HFrEF, EF <40%). The main indication for CMR was to investigate the aetiology of new left ventricular systolic dysfunction (56%). CMR for viability studies were requested in 16% patients. 76% patients had invasive coronary angiogram prior to CMR imaging. Following CMR, the aetiology of heart failure was non-ischaemic in 65% patients. 10 (12%) patients were re-admitted in 30 days following hospital discharge. There were MACE in 6% (5) patients including arrhythmia and stroke. Mortality was 2% (2 patients) during admission, no patients died within 30 days of discharge, 1 patient died within 90 days of discharge. A logistic regression analysis to determine the association of CMR parameters with re-admission and mortality at 30 days was performed (Table 1). LA area was the only CMR parameter significantly associated with death or re-admission. Conclusions Left atrial enlargement (LAE) on CMR imaging was independently associated with death, increased morbidity and re-admission in patients with acute heart failure. This is the first study to evaluate LAE on CMR and its association with poor prognostic outcomes in acute heart failure. This specific sub-group of patients may benefit from earlier treatment intensification given the association with poorer outcomes. Further prospective studies targeting these patients with earlier follow up and closer monitoring should be considered. Conflict of Interest Nil

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.