Shinya Yamada

and 7 more

Background: The combination of electrical and structural remodeling may have a strong effect on the prognosis of non-ischemic heart failure (HF). We aimed to clarify whether prolonged PR-interval and the presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) influence the outcomes of patients with non-ischemic HF. Methods: We studied 262 consecutive hospitalized patients with non-ischemic HF. In a clinically stable condition, a 12-lead electrocardiogram and CMR were performed, and the clinical characteristics and outcomes were investigated. Results: During the follow-up of 967.7±851.8 days, there were 68 (25.9%) cardiac events (HF or sudden death, re-hospitalization due to HF, or ventricular tachyarrhythmias). In a multivariable analysis, a median rate-adjusted PR (PRa)-interval of ≥173.5 ms and the presence of LGE were associated with cardiac events with a hazard ratio of 1.690 and 2.045 (P=0.044 and P=0.006, respectively). Study subjects were then divided into three groups based on PRa-interval and LGE status. The patients were given 1 point each for PRa-interval of ≥173.5 ms and the presence of LGE: score of 0 (n=79), score of 1 (n=123) and score of 2 (n=60). Cardiac events were 16.4% in score of 0, 26.0% in score of 1 and 38.3% in score of 2 (P=0.005), respectively. The multivariable analysis showed that score of 2 was an independent predictor for cardiac events compared to score of 0 (hazard ratio, 3.437, P=0.001). Conclusions: The combination of a long PRa-interval and the presence of LGE provides a better predictive value of cardiac events in non-ischemic HF.