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

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 a...

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Published inEuropean 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
LanguageEnglish
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
Online AccessGet full text
ISSN0195-668X
1522-9645
1522-9645
DOI10.1093/eurheartj/ehy713

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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.
AbstractList 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.AimsNon-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.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.Methods and resultsThe 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.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.ConclusionMajor 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.
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. 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. 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.
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.
Author Aspelund, Thor
þorgeirsson, Guðmundur
Schelbert, Erik B
Greve, Anders M
Cao, J Jane
Danielsen, Ragnar
Launer, Lenore J
Harris, Tamara B
Shanbhag, Sujata M
Arai, Andrew E
Eiríksdóttir, Guðný
Sigurðsson, Sigurður
Guðnason, Vilmundur
AuthorAffiliation 2 Department of Clinical Biochemistry, Rigshospitalet, 9 Blegdamsvej, Copenhagen, Denmark
7 Laboratory of Epidemiology & Population Science, National Institute on Aging, National Institutes of Health, Department of Health and Human Services, GWY Bldg Rm 2N300, 7201 Wisconsin Ave, Bethesda, MD, USA
1 Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Dr., Bethesda, MD, USA
3 Hjartavernd (Icelandic Heart Association), Holtasmari 1, Kopavogur, Iceland
5 University of Pittsburgh Medical Center, Heart and Vascular Institute, 200 Lothrop St., Ste. A349, Pittsburgh, PA, USA
4 University of Iceland, Sæmundargata 2, Reykjavik, Iceland
6 St. Francis Hospital, The heart Center, State University of New York at Stony Brook, 100 Port Washington Blvd, Roslyn, NY, USA
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  surname: Schelbert
  fullname: Schelbert, Erik B
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  surname: Cao
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  givenname: Tamara B
  surname: Harris
  fullname: Harris, Tamara B
  organization: Laboratory of Epidemiology & Population Science, National Institute on Aging, National Institutes of Health, Department of Health and Human Services, GWY Bldg Rm 2N300, 7201 Wisconsin Ave, Bethesda, MD, USA
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  surname: Arai
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  email: araia@nih.gov
  organization: Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Dr., Bethesda, MD, USA
BackLink https://www.ncbi.nlm.nih.gov/pubmed/30445559$$D View this record in MEDLINE/PubMed
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Issue 6
Keywords Myocardial infarction
Gadolinium
Non-ischaemic cardiomyopathy
Prognosis
Fibrosis
Language English
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Sujata M. Shanbhag and Anders M. Greve authors served as co-first author.
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30590579 - Eur Heart J. 2019 Feb 7;40(6):539-541. doi: 10.1093/eurheartj/ehy876.
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Snippet Abstract Aims Non-ischaemic cardiomyopathies (NICM) can cause heart failure and death. Cardiac magnetic resonance (CMR) detects myocardial scar/fibrosis...
Non-ischaemic cardiomyopathies (NICM) can cause heart failure and death. Cardiac magnetic resonance (CMR) detects myocardial scar/fibrosis associated with...
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SubjectTerms 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
Title Prevalence and prognosis of ischaemic and non-ischaemic myocardial fibrosis in older adults
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