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Heart failure & cardiomyopathiesCohort study

Apical myocardial fibrosis burden identifies a high-risk phenotype and predicts cardiac mortality after left ventricular assist device (LVAD) implantation

ESC Heart FailPublished

  • single-centre retrospective cohort study
  • consecutive patients
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Authors' conclusion

Quantitatively assessed apical myocardial fibrosis burden identifies a biologically high-risk myocardial phenotype in LVAD recipients. While the association with all-cause mortality is attenuated after adjustment, fibrosis burden shows a specific relationship with cardiac mortality when competing non-cardiac risk is taken into account. These findings support the prognostic relevance of myocardial substrate and warrant external validation in larger prospective cohorts.

Study context

Population
Patients undergoing durable LVAD implantation between 2019 and 2025consecutive patients undergoing durable LVAD implantation
Participants
47 patients
Exposure
Quantitatively assessed apical myocardial fibrosis burden at LVAD implantation and overall and cause-specific mortality

Main finding

As reported in the abstract

Deaths during follow-up · Median follow-up 1513 days

Deaths

27 deaths occurred (57.4%)

Cardiovascular deaths

16

Non-cardiac deaths

11

Observational data: associations, not effects.

Further findings

Mortality, univariable Cox analysis

ComparisonHR (95% CI)P value
fibrosis burden · univariable39.39 (2.61–594.56)P = 0.008
THS-10 score · univariable1.51 (1.14–2.01)P = 0.005
Outcomesubdistribution HRP value
Cardiac mortality, competing-risk analysis · non-cardiac death as competing event · Fine-Gray competing-risk modelapproximately 4.1P = 0.02

Overall survival by quantitative fibrosis burden

Strong unadjusted association with overall survival
log-rank P = .00042

All-cause mortality after multivariable adjustment

Association attenuated after adjustment for clinical severity, including INTERMACS profile and key laboratory parameters

ROC analysis for overall mortality risk stratification

Cohort-derived fibrosis threshold
33.7%
AUC
0.739, 95% confidence interval [CI] 0.566-0.912

Exploratory ROC analysis for cardiovascular death

AUC
0.752
Cohort-derived threshold
39.6%
  • exploratory

Original publication

Apical myocardial fibrosis burden identifies a high-risk phenotype and predicts cardiac mortality after LVAD implantation. ESC Heart Fail. Published 12 May 2026. doi:10.1093/eschf/xvag135
Read the original article ↗PubMedCite RIS · BibTeX

Summarised from the published abstract; every number is checked against it