Heart failure & cardiomyopathies
Apical myocardial fibrosis burden identifies a high-risk phenotype and predicts cardiac mortality after left ventricular assist device (LVAD) implantation
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
- Outcome
- Deaths during follow-up
- Follow-up
- Median 1513 days
Methodological detailsconsecutive patients
- Consecutive patients
Main finding
As reported in the abstract
Deaths
27 deaths occurred
57.4%
Cardiovascular deaths
16
Non-cardiac deaths
11
Observational data: associations, not effects.
Further findings
Mortality, univariable Cox analysis
| HR (95% CI) | P value | ||
|---|---|---|---|
| Fibrosis burdenUnivariable | 39.39 (2.61–594.56) | P = 0.008 | |
| THS-10 scoreUnivariable | 1.51 (1.14–2.01) | P = 0.005 | |
| 0.050.21520Hazard ratio (log scale) |
| Outcome | Subdistribution HR | P value |
|---|---|---|
| Cardiac mortality, competing-risk analysisNon-cardiac death as competing event · Fine-Gray competing-risk model | ≈4.1 | P = 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
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