The independent factors associated with myocardial extracellular volume fraction in acute decompensated heart failure patients

Abstract Background Myocardial eextracellular volume (ECV) fraction is an important metric for myocardial fibrosis. However, the associated factors for the level of ECV had not been fully explored. Purpose This study focuses on the connection between trimethylamine-N-oxide (TMAO) and myocardial ECV, and their effects in the prognosis of heart failure (HF). Methods The prospective cohort study included 284 HF patients with cardiovascular magnetic resonance (CMR) examination for analysis. Myocardial ECV fraction was evaluated by CMR. Serum TMAO was analyzed using liquid chromatography-time of flight mass spectrometry. The primary end-points were defined as a composite events consisting of all-cause death and HF rehospitalisation during follow-up. Results In a median follow-up duration of 14.1 months, 109 (38.4%) patients reached the composite primary outcomes as defined. In univariate Cox regression models, ECV fraction showed a most significant strength of association (per doubling, HR 4.55, 95%CI 1.96–10.60) with the primary outcomes in HF, and weakened in multivariate Cox regression models (per doubling, HR 2.85, 95%CI 1.21–6.70). Other independent risk factors including TMAO, age, and higher hs-CRP, while higher level of LVEF was associated with a lower risk of primary outcomes. Multivariate linear regression analysis showed that levels of hs-CRP (rpartial=0.13, P=0.035), NT-proBNP (rpartial=0.19, P=0.001) and TMAO (rpartial=0.17, P=0.004), were independent factors associated with ECV fraction. Conclusion Serum TMAO, as well as levels of hs-CRP and NT-proBNP, could serve as independent factors associated with myocardial ECV fraction and is importantly associated with worse outcomes in patients with HF.