Background
Methods
Study population
CMR image acquisition
LV myocardial strain analysis
LGE measurement
Follow-up and endpoints
Statistical analysis
Results
Baseline characteristics
Parameters
|
All patients (n = 172)
|
Patients without the primary outcome (n = 129)
|
Patients with the primary outcome (n = 43)
|
P value
|
---|---|---|---|---|
Age (years) | 56.4 ± 14.3 | 57.0 ± 14.6 | 54.8 ± 13.5 | 0.398 |
Male gender, n (%) | 116 (67.4) | 85 (65.9) | 31 (72.1) | 0.452 |
Mean arterial pressure (mmHg) | 84 ± 13 | 86 ± 13 | 80 ± 12 | 0.015 |
Hypertension, n (%) | 58 (33.7) | 44 (34.1) | 14 (32.6) | 0.852 |
Diabetes mellitus, n (%) | 36 (20.9) | 25 (19.4) | 11 (25.6) | 0.387 |
Dyslipidemia, n (%) | 11 (6.4) | 8 (6.2) | 3 (7.0) | 0.857 |
Current smoker, n (%) | 49 (28.5) | 37 (28.7) | 12 (27.9) | 0.734 |
Chronic kidney diseasea, n (%) | 31 (18.0) | 21 (16.3) | 10 (23.3) | 0.303 |
Previous CVA, n (%) | 4 (2.3) | 1 (0.8) | 3 (7.0) | 0.049 |
Body mass index (kg/m2) | 24.0 ± 4.5 | 24.2 ± 4.5 | 23.5 ± 4.4 | 0.347 |
ECG at baseline | ||||
Heart rate (bpm) | 83 ± 20 | 84 ± 19 | 83 ± 22 | 0.883 |
Left bundle-branch block, n (%) | 31 (18.0) | 23 (17.8) | 8 (19.0) | 0.859 |
QRS duration (ms) | 113 ± 29 | 112 ± 30 | 117 ± 29 | 0.305 |
Laboratory data | ||||
Serum creatinine (mg/dl) | 0.97 ± 0.27 | 0.96 ± 0.25 | 1.01 ± 0.31 | 0.247 |
Na (mmol/l) | 139.6 ± 3.3 | 140.2 ± 2.8 | 137.6 ± 3.8 | < 0.001 |
ln(NT-proBNP) (pg/ml) | 7.22 ± 1.27 | 7.08 ± 1.29 | 7.60 ± 1.16 | 0.022 |
Cardiac medications | ||||
Beta-blockers, n (%) | 120 (69.8) | 87 (67.4) | 33 (76.7) | 0.250 |
ACE-inhibitors/ARB, n(%) | 134 (77.9) | 104 (80.6) | 39 (90.7) | 0.126 |
Spironolactone, n (%) | 101 (58.7) | 74 (57.4) | 27 (62.8) | 0.531 |
Diuretics, n (%) | 125 (72.7) | 93 (72.1) | 32 (74.4) | 0.767 |
Digoxin, n (%) | 33 (19.2) | 21 (16.3) | 12 (27.9) | 0.094 |
Parameters
|
All patients (n = 172)
|
Patients without the primary outcome (n = 129)
|
Patients with the primary outcome (n = 43)
|
P value
|
---|---|---|---|---|
LV EF (%) | 23.7 ± 7.9 | 23.6 ± 8.0 | 24.1 ± 7.5 | 0.675 |
LV EDV (ml) | 284.3 ± 91.4 | 279.2 ± 81.5 | 299.9 ± 116.0 | 0.199 |
LV ESV (ml) | 219.9 ± 85.7 | 215.5 ± 76.4 | 233.2 ± 109.0 | 0.242 |
Cardiac output (L/min) | 5.04 ± 1.53 | 4.95 ± 1.51 | 5.32 ± 1.57 | 0.166 |
Cardiac index (L/min/m2) | 2.95 ± 0.84 | 2.89 ± 0.82 | 3.12 ± 0.88 | 0.114 |
RV EF (%) | 41.2 ± 17.0 | 42.3 ± 18.0 | 37.7 ± 12.8 | 0.129 |
RV EDV (ml) | 145.6 ± 60.7 | 140.7 ± 56.3 | 160.3 ± 70.9 | 0.066 |
RV ESV (ml) | 91.6 ± 56.7 | 87.1 ± 53.8 | 105.1 ± 63.3 | 0.071 |
RV cardiac output (L/min) | 4.21 ± 1.33 | 4.14 ± 1.23 | 4.43 ± 1.59 | 0.227 |
Presence of LGE, n (%) | 66 (38.4) | 42 (33.1) | 24 (58.5) | 0.004 |
Myocardial mass (g) | 142.2 ± 41.1 | 144.1 ± 43.6 | 136.5 ± 31.9 | 0.232 |
Quantitative LGE mass (g) | 6.8 ± 14.5 | 5.6 ± 13.3 | 10.6 ± 17.2 | 0.093 |
LGE mass/LV myocardial mass (%) | 4.7 ± 9.5 | 3.8 ± 8.6 | 7.4 ± 11.5 | 0.073 |
Global radial strain (%) | 12.3 ± 5.6 | 12.5 ± 5.6 | 11.9 ± 5.8 | 0.563 |
Global circumferential strain (%) | −7.3 ± 3.1 | −7.3 ± 3.1 | −7.2 ± 3.2 | 0.869 |
Global longitudinal strain (%) | −7.1 ± 2.9 | −7.2 ± 2.9 | −6.9 ± 2.7 | 0.613 |
Outcomes
Survival analysis
Primary outcome
|
Secondary outcome
| |||||
---|---|---|---|---|---|---|
HR
|
95% CI
|
P value
|
HR
|
95% CI
|
P value
| |
Age (years) | 0.993 | 0.973–1.013 | 0.487 | 0.991 | 0.970–1.011 | 0.373 |
Male gender | 1.350 | 0.693–2.631 | 0.378 | 0.726 | 0.388–1.361 | 0.318 |
Mean arterial pressure (mmHg) | 0.971 | 0.945–0.997 | 0.028 | 0.959 | 0.931–0.986 | 0.004 |
Hypertension | 1.257 | 0.663–2.384 | 0.483 | 0.896 | 0.449–1.789 | 0.756 |
Diabetes mellitus | 1.417 | 0.712–2.818 | 0.321 | 1.387 | 0.679–2.833 | 0.369 |
Dyslipidemia | 1.521 | 0.469–4.936 | 0.485 | 0.945 | 0.228–3.917 | 0.938 |
Current smoker | 0.978 | 0.474–2.017 | 0.951 | 0.853 | 0.403–1.807 | 0.678 |
Chronic kidney diseasea | 1.660 | 0.813–3.389 | 0.164 | 1.709 | 0.837–3.492 | 0.141 |
Previous CVA | 3.501 | 1.079–11.362 | 0.037 | 2.265 | 0.545–9.418 | 0.261 |
Body mass index, kg/m2 | 0.960 | 0.888–1.037 | 0.298 | 0.936 | 0.858–1.021 | 0.134 |
ECG at baseline | ||||||
Heart rate (bpm) | 1.000 | 0.984–1.015 | 0.972 | 1.013 | 0.997–1.029 | 0.109 |
Left bundle-branch block | 1.122 | 0.519–2.426 | 0.770 | 1.580 | 0.774–3.224 | 0.209 |
QRS duration (ms) | 1.005 | 0.995–1.015 | 0.353 | 1.003 | 0.993–1.013 | 0.598 |
Laboratory data | ||||||
Serum creatinine (mg/dl) | 2.249 | 0.784–6.455 | 0.132 | 0.950 | 0.271–3.334 | 0.950 |
Na (mmol/l) | 0.810 | 0.751–0.875 | < 0.001 | 0.860 | 0.794–0.931 | < 0.001 |
ln(NT-proBNP) (pg/ml) | 1.376 | 1.083–1.748 | 0.009 | 1.519 | 1.190–1.939 | 0.001 |
Cardiac medications | ||||||
Beta-blockers | 1.148 | 0.564–2.334 | 0.704 | 0.767 | 0.396–1.486 | 0.432 |
ACE-inhibitors/ARB | 1.492 | 0.531–4.192 | 0.447 | 2.171 | 0.669–7.050 | 0.197 |
Spironolactone | 1.100 | 0.588–2.056 | 0.766 | 1.380 | 0.724–2.632 | 0.328 |
Diuretics | 0.921 | 0.463–1.832 | 0.814 | 1.732 | 0.767–3.914 | 0.187 |
Digoxin | 1.658 | 0.847–3.242 | 0.140 | 1.662 | 0.847–3.258 | 0.140 |
LV EF (%) | 1.006 | 0.969–1.044 | 0.759 | 0.970 | 0.933–1.009 | 0.132 |
LV EDV (ml) | 1.003 | 1.000–1.006 | 0.093 | 1.003 | 1.000–1.006 | 0.090 |
LV ESV (ml) | 1.003 | 0.999–1.006 | 0.108 | 1.004 | 1.000–1.007 | 0.041 |
Cardiac output (L/min) | 1.092 | 0.908–1.314 | 0.349 | 0.961 | 0.784–1.177 | 0.699 |
Cardiac index (L/min/m2) | 1.228 | 0.868–1.738 | 0.245 | 1.024 | 0.708–1.481 | 0.901 |
RV EF (%) | 0.984 | 0.964–1.005 | 0.124 | 0.976 | 0.955–0.998 | 0.033 |
RV EDV (ml) | 1.005 | 1.000–1.009 | 0.041 | 1.004 | 0.999–1.009 | 0.080 |
RV ESV (ml) | 1.005 | 1.000–1.009 | 0.049 | 1.005 | 1.000–1.010 | 0.045 |
RV stroke volume (ml) | 1.007 | 0.991–1.024 | 0.376 | 0.995 | 0.977–1.012 | 0.556 |
RV cardiac output (L/min) | 1.122 | 0.894–1.407 | 0.320 | 0.962 | 0.759–1.220 | 0.751 |
Presence of LGE | 2.277 | 1.221–4.246 | 0.010 | 2.023 | 1.066–3.839 | 0.031 |
Myocardial mass (g) | 0.997 | 0.990–1.005 | 0.510 | 0.987 | 0.978–0.997 | 0.008 |
Quantitative LGE mass (g) | 1.014 | 0.998–1.031 | 0.086 | 1.009 | 0.990–1.028 | 0.370 |
LGE mass/LV myocardial mass (%) | 1.024 | 0.998–1.051 | 0.068 | 1.018 | 0.989–1.047 | 0.232 |
Global radial strain (%) | 0.974 | 0.921–1.030 | 0.363 | 0.955 | 0.901–1.013 | 0.129 |
Global circumferential strain (%) | 1.030 | 0.934–1.136 | 0.554 | 1.062 | 0.963–1.172 | 0.229 |
Global longitudinal strain (%) | 1.048 | 0.945–1.163 | 0.375 | 1.066 | 0.955–1.191 | 0.254 |
Primary outcome
a
|
Secondary outcome
| |||||
---|---|---|---|---|---|---|
HR
|
95% CI
|
P value
|
HR
|
95% CI
|
P value
| |
Na (mmol/l) | 0.821 | 0.761–0.885 | < 0.001 | 0.896 | 0.817–0.982 | 0.019 |
Presence of LGE | 4.729 | 1.111–20.121 | 0.0355 | 2.358 | 1.229–4.523 | 0.010 |
Myocardial mass | 0.986 | 0.975–0.996 | 0.009 | |||
lnNT-proBNP | 1.352 | 1.031–1.771 | 0.029 |