Purpose Heart failure with preserved ejection fraction (HFpEF) is a poorly characterised condition. We aimed to phenotype patients with HFpEF using multiparametric stress cardiovascular magnetic resonance imaging (CMR) and assess the relationship to clinical outcomes.

Methods and Results Patients were recruited as part of an observational, single-centre, cohort study. Inclusion criteria were: clinical or radiographic evidence of heart failure (HF) and ejection fraction > 50% on transthoracic echocardiography (TTE). Exclusion criteria were: myocardial infarction (MI) in the preceding 6 months, suspected or confirmed cardiomyopathy/ constrictive pericarditis, non-cardiovascular life expectancy < 6 months and severe valve/ lung/ renal disease.

Patients labelled as HFpEF (n = 154, 51% male, mean age 72.4 ± 10 years) underwent TTE and CMR during a single study visit. The CMR protocol comprised cine, stress/rest perfusion and late gadolinium enhancement imaging on a 3-Tesla scanner. Follow-up outcome data (death or HF hospitalisation) was captured after a minimum of 6 months.

CMR detected previously undiagnosed pathology in 42 patients (27%), who had similar baseline characteristics to those without a new diagnosis (see Table 1). These diagnoses consisted of: coronary artery disease (n = 20, including 14 with ‘silent’ MI), microvascular dysfunction (n = 11), probable or definite hypertrophic cardiomyopathy (n = 10) and constrictive pericarditis (n = 5). Four patients had dual pathology. During follow-up (median = 623 days), those patients with a new CMR diagnosis were at higher risk (see Figure 1) of adverse outcome for the composite end-point (hazard ratio log rank test: p = 0.047). In multivariate analysis, the ‘new CMR diagnoses’ group remained an independent predictor of outcome (hazard ratio: 1.92; 95% CI: 1.07 to 3.45; p = 0.03).

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Abstract 12 Figure 1

Kaplan-Meier survival plots for the composite end-point of death and/or re-hospitalisation from heart failure stratified according to new CMR diagnosis versus no new diagnosis

Conclusion Stress CMR diagnosed new significant pathology in 27% of patients with HFpEF and these patients were at increased risk of death and HF hospitalisation.

Conflicts of interest On behalf of all authors, there are no conflicts of interest to declare.