Prevalence and prognosis of ischaemic and non-ischaemic myocardial fibrosis in older adults. (16th November 2018)

• Record Type: Journal Article
• Authors: Shanbhag, Sujata M; Greve, Anders M; Aspelund, Thor; Schelbert, Erik B; Cao, J Jane; Danielsen, Ragnar; þorgeirsson, Guðmundur; Sigurðsson, Sigurður; Eiríksdóttir, Guðný; Harris, Tamara B; Launer, Lenore J; Guðnason, Vilmundur; Arai, Andrew E
• Is Part Of: European heart journal. Volume 40:Number 6(2019)
• Page Start: 529
• Page End: 538
• Publication Date: 2018-11-16
• Subjects: Fibrosis -- Prognosis -- Gadolinium -- Myocardial infarction -- Non-ischaemic cardiomyopathy; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehy713
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: Non-ischaemic cardiomyopathies (NICM) can cause heart failure and death. Cardiac magnetic resonance (CMR) detects myocardial scar/fibrosis associated with myocardial infarction (MI) and NICM with late gadolinium enhancement (LGE). The aim of this study was to determine the prevalence and prognosis of ischaemic and non-ischaemic myocardial fibrosis in a community-based sample of older adults. Methods and results: The ICELAND-MI cohort, a substudy of the Age, Gene/Environment Susceptibility Reykjavik (AGES-Reykjavik) study, provided a well-characterized population of 900 subjects after excluding subjects with pre-existing heart failure. Late gadolinium enhancement CMR divided subjects into four groups: MI ( n = 211), major ( n = 54) non-ischaemic fibrosis (well-established, classic patterns, associated with myocarditis, infiltrative cardiomyopathies, or pathological hypertrophy), minor ( n = 238) non-ischaemic fibrosis (remaining localized patterns not meeting major criteria), and a no LGE ( n = 397) reference group. The primary outcome was time to death or first heart failure hospitalization. During a median follow-up of 5.8 years, 192 composite events occurred (115 deaths and 77 hospitalizations for incident heart failure). After inverse probability weighting, major non-ischaemic fibrosis [hazard ratio (HR) 3.2, P < 0.001] remained independently associated with the primary endpoint, while MI (HR 1.4, P = 0.10) and minor non-ischaemic LGE (HR 1.2, P = 0.39) did not. Major non-ischaemic fibrosis was associated with a poorer outcome than MI (HR = 2.3, P = 0.001) in the adjusted analysis. Conclusion: Major non-ischaemic patterns of myocardial fibrosis portended worse prognosis than no fibrosis/scar in an older community-based cohort. Traditional risk factors largely accounted for the effect of MI and minor non-ischaemic LGE.