Heart failure (HF) with mid-range or preserved ejection fraction (HFmrEF; HFpEF) is a heterogeneous disorder that could benefit from strategies to identify subpopulations at increased risk. We tested the hypothesis that HFmrEF and HFpEF patients with myocardial scars detected with late gadolinium enhancement (LGE) are at increased risk for all-cause mortality. Symptomatic HF patients with left ventricular ejection fraction (LVEF) > 40%, who underwent cardiac magnetic resonance (CMR) imaging were included. The presence of myocardial LGE lesions was visually assessed. T1 mapping was performed to calculate extracellular volume (ECV). Multivariable logistic regression analyses were used to determine associations between clinical characteristics and LGE. Cox regression analyses were used to assess the association between LGE and all-cause mortality. A total of 110 consecutive patients were included (mean age 71 ± 10 years, 49% women, median N-terminal brain natriuretic peptide (NT-proBNP) 1259 pg/ml). LGE lesions were detected in 37 (34%) patients. Previous myocardial infarction and increased LV mass index were strong and independent predictors for the presence of LGE (odds ratio 6.32, 95% confidence interval (CI) 2.07–19.31, p = 0.001 and 1.68 (1.03–2.73), p = 0.04, respectively). ECV was increased in patients with LGE lesions compared to those without (28.6 vs. 26.6%, p = 0.04). The presence of LGE lesions was associated with a fivefold increase in the incidence of all-cause mortality (hazards ratio 5.3, CI 1.5–18.1, p = 0.009), independent of age, sex, New York Heart Association (NYHA) functional class, NT-proBNP, LGE mass and LVEF. Myocardial scarring on CMR is associated with increased mortality in HF patients with LVEF > 40% and may aid in selecting a subpopulation at increased risk.

射血分数中等或保留的心力衰竭 (HF) (HFmrEF; HFpEF) 是一种异质性疾病，可以从识别高风险亚群的策略中受益。我们检验了以下假设，即 HFmrEF 和 HFpEF 患者的心肌瘢痕经晚期钆增强 (LGE) 检测后全因死亡风险增加。包括接受心脏磁共振 (CMR) 成像的左心室射血分数 (LVEF) > 40% 的有症状心衰患者。目测评估心肌 LGE 损伤的存在。进行 T1 映射以计算细胞外体积 (ECV)。多变量逻辑回归分析用于确定临床特征与 LGE 之间的关联。Cox 回归分析用于评估 LGE 与全因死亡率之间的关联。共纳入 110 名连续患者（平均年龄 71 ± 10 岁，49% 为女性，N 末端脑钠肽 (NT-proBNP) 中位数为 1259 pg/ml）。在 37 名 (34%) 患者中检测到 LGE 病变。既往心肌梗死和左室质量指数增加是存在 LGE 的强且独立的预测因子（优势比 6.32，95% 置信区间 (CI) 2.07-19.31，p  = 0.001 和 1.68 (1.03–2.73)，p  = 0.04，分别）。与没有 LGE 病变的患者相比，有 LGE 病变的患者的 ECV 增加（28.6% vs. 26.6%，p  = 0.04）。LGE 病变的存在与全因死亡率增加五倍相关（风险比 5.3，CI 1.5-18.1，p  = 0.009），与年龄、性别、纽约心脏协会 (NYHA) 功能分级无关， NT-proBNP、LGE 质量和 LVEF。CMR 上的心肌瘢痕与 LVEF > 40% 的 HF 患者死亡率增加相关，并且可能有助于选择风险增加的亚群。