Can 3D RVEF be Prognostic for the Non-Ischemic Cardiomyopathy Patient but not the Ischemic Cardiomyopathy Patient? A Cardiovascular MRI Study

Cardiac magnetic resonance for prophylactic implantable-cardioverter defibrillator therapy international study: prognostic value of cardiac magnetic resonance-derived right ventricular parameters substudy

AIMS

Right ventricular systolic dysfunction (RVSD) is an important determinant of outcomes in heart failure (HF) cohorts. While the quantitative assessment of RV function is challenging using 2D-echocardiography, cardiac magnetic resonance (CMR) is the gold standard with its high spatial resolution and precise anatomical definition. We sought to investigate the prognostic value of CMR-derived RV systolic function in a large cohort of HF with reduced ejection fraction (HFrEF).

METHODS AND RESULTS

Study cohort comprised of patients enrolled in the CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DefibrillAtor ThErapy registry who had HFrEF and had simultaneous baseline CMR and echocardiography (n = 2449). RVSD was defined as RV ejection fraction (RVEF) <45%. Kaplan-Meier curves and cox regression were used to investigate the association between RVSD and all-cause mortality (ACM). Mean age was 59.8 ± 14.0 years, 42.0% were female, and mean left ventricular ejection fraction (LVEF) was 34.0 ± 10.8. Median follow-up was 959 days (interquartile range: 560-1590). RVSD was present in 936 (38.2%) and was an independent predictor of ACM (adjusted hazard ratio = 1.44; 95% CI [1.09-1.91]; P = 0.01). On subgroup analyses, the prognostic value of RVSD was more pronounced in NYHA I/II than in NYHA III/IV, in LVEF <35% than in LVEF ≥35%, and in patients with renal dysfunction when compared to those with normal renal function.

CONCLUSION

RV systolic dysfunction is an independent predictor of ACM in HFrEF, with a more pronounced prognostic value in select subgroups, likely reflecting the importance of RVSD in the early stages of HF progression.

Level and clinical significance of serum bFGF in patients with ischemic cardiomyopathy

OBJECTIVE

To detect the level of serum basic fibroblast growth factor (bFGF) in patients with ischemic cardiomyopathy (ICM) and analyze its clinical significance.

METHODS

This is a prospective study. From June 2018 to June 2021, 244 patients diagnosed with ICM in the department of cardiology of Tianyou Hospital Affiliated to Wuhan University of Science and Technology and 244 healthy people who underwent physical examination in the physical examination center of our hospital during the same period were enrolled as the research subjects. Serum bFGF level was measured by ELISA kit, and the ICM patients were divided into a high bFGF group (180 cases) and a low bFGF group (64 cases) according to the cut-off value 56.83 obtained from X-tile software analysis, and the clinical data of the two groups were compared. In addition, according to the 12-month survival, the patients were grouped into a poor prognosis group (56 cases) and a good prognosis group (188 cases). Then, univariate and multivariate proportional hazards model (COX regression) analyses were applied to analyze the influencing factors of poor prognosis in ICM patients.

RESULTS

In the ICM group, there were more patients with hypertension and diabetes, and patients had higher levels of HbA1c, blood urea nitrogen, creatinine and uric acid, and lower levels of eGFR and bFGF than patients in the control group (P<0.05). The 12-month endpoint event rate in the low bFGF group was 54.69%, which was significantly higher than 11.67% in the high bFGF group (P<0.05). The left ventricular ejection fraction (LVEF) in the low bFGF group was significantly lower than that in the high bFGF group, and the bFGF group also had more patients with cardiac function grade IV (P<0.05). Multivariate COX regression analysis showed that age, diabetes, LVEF and low bFGF were independent influencing factors of poor prognosis in patients with ICM (P<0.05). After adjusting for age, diabetes and LVEF, patients with low bFGF had a higher risk of poor prognosis than those with high bFGF (HR=4.416, 95 CI%: 1.977-9.863, P<0.05).

CONCLUSION

The serum expression of bFGF in ICM patients is low, and the risk of poor prognosis is higher in patients with low bFGF, suggesting that serum bFGF level has a certain value in the prognosis evaluation of ICM patients.