Prevalence and prognosis of ischaemic and non-ischaemic myocardial fibrosis in older adults

• Published in: European heart journal Vol. 40; no. 6; pp. 529 - 538
• Main 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
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 07.02.2019
• Subjects: Aged; Aged, 80 and over; Cardiomyopathies - diagnosis; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - epidemiology; Cardiomyopathies - pathology; Clinical Research; Editor's Choice; Female; Fibrosis; Heart - diagnostic imaging; Humans; Magnetic Resonance Imaging; Male; Myocardial Ischemia - diagnosis; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - epidemiology; Myocardial Ischemia - pathology; Myocardium - pathology; Prevalence; Prognosis; Myocardial infarction; Gadolinium; Non-ischaemic cardiomyopathy; Prognosis; Fibrosis
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehy713

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.