Identifying Predictors of Myocardial Recovery Among Patients Hospitalized for non-ischemic heart failutre: MRI substudy - J. Wilcox HFSA AY15

We are currently developing a prediction tool (supported by an AHA postdoctoral award to the PI [J. Wilcox]) which uses clinical covariates that predict myocardial recovery (>10% absolute improvement in LVEF) in a large EMR-based study at Northwestern University. We will also prospectively determine whether myocardial recovery is associated with cardiovascular outcomes including mortality. As part of the prospective phase of we are conducting a nested study to perform comprehensive echocardiography, including tissue Doppler and speckle tracking) and six-minute walk tests (6MWT) in a subset of patients (n=20) at index hospitalization, and at 6- and 12-month follow-up visit. The goal of this HFSA grant is to add tissue characterization of myocardial substrate using contrast-enhanced cardiac MRI (CMR) to enhance our understanding of the myocardial substrate that is associated with recovery of LVEF. Nonviable myocardium [presence of late gadolinium enhancement (LGE)] and interstitial fibrosis (T1 mapping) on CMR are important prognostic factors but this technology is not widely available. Prior work demonstrates that global longitudinal strain (GLS) allows indirect evaluation of LGE. It is unclear if GLS correlates with diffuse myocardial fibrosis (T1 mapping) often seen in NICM. Passive leg-raise, an easy bedside maneuver, can identify echocardiographic markers of LV stiffness/impaired diastolic function. Our hypothesis is that interstitial fibrosis on CMR: (1) positively correlates with echo parameters of LV mechanics (GLS) and worse diastology with leg-raise; and (2) negatively correlates with functional capacity and myocardial recovery. Adequately phenotyping this population sets the stage to provide cost-effective, personalized care for HHF patients.