P5268Prognostic Implications of Cardiac Magnetic Resonance in Patient with Mid Range Ejection Fraction: Can We Predict Worse Outcomes?

Abstract Purpose According to current ESC guidelines, mid-range ejection fraction (mrEF) might represent a separate subgroup of patients with distinct underlying characteristics, prognosis and treatment response. Cardiac magnetic resonance (CMR) is the gold standard for measuring volumes, mass and ejection fraction of the heart. We aimed to find long-term prognostic value of various CMR parameters in patients mrEF. Methods 137 patients with mrEF underwent CMR (1.5T) between 2012 and 2018 and were consecutively included. Volumes, mass and ejection fraction were assessed using short axis SSFP images and the Simpson method (using commercially available software). Myocardial fibrosis was determined by late gadolinium enhancement (LGE). Clinical parameters after a median of 762 (230–1315 days) were recorded. Patients with other significant cardiac affection rather than mrEF were excluded (pre-capillary pulmonary hypertension and significant valve disease). The primary endpoint was defined as a combined outcome of all-cause death or heart failure decompensation requiring in-hospital admission. Results Mean age was 63.0±12.4 years. 76.6% were males. Mean left ventricle ejection fraction (LVEF) was 45±2.69%. Main aetiologies were ischemic (46%), idiopathic (32.12%), myocarditis (9.5%), tachycardiomyopathy (6.57%) enolic (2.2%) stress cardiomyopathy (0.7%) and others (2.9%). A combined model for predicting outcomes in patients with mrEF using CMR parameters was obtained. This model was able to predict 32.7% (coefficient of determination, R-squared) of the adverse events (p<0.01). Significant CMR parameters and results are shown on table 1. Combined model for predicting outcomes in patients with mrEF using CMR parameters Variable p value iRVEDV (indexed right ventricular end-diastolic volume) <0.01 RVEF (right ventricle ejection fraction 0.03 iRVESV (indexed right ventricular end-systolic volume) <0.01 Presence of late enhancement (yes/no) 0.09 iLA (indexed left atrial) Volume <0.01 iLV (indexed left ventricle) mass <0.01 Variables and their significance are shown individually. Conclusions In patients with mid-range ejection fraction, RV volumes and ejection fraction, as well as LV mass and LA volume, were significant predictors of worse outcomes in a combined model. If supported by further studies, these findings may help the clinician select the patients with higher risk of complications and in need of a closer follow-up.