{
  "abstract": "Background Heart failure with preserved ejection fraction (HFpEF) lacks robust imaging biomarkers for prognostic stratification. Cardiac magnetic resonance (CMR) T1 mapping–derived extracellular volume (ECV) enables non-invasive quantification of diffuse myocardial fibrosis, a central HFpEF pathophysiological mechanism. However, its prognostic value across HFpEF cohorts has not been comprehensively quantified. Given this research gap, we performed a systematic review and meta-analysis to evaluate the prognostic significance of ECV in HFpEF.Methods In a PROSPERO-registered systematic review, we searched MEDLINE (PubMed), EMBASE, Web of Science, and Cochrane CENTRAL. Studies enrolling adults with HFpEF (LVEF ≥50%) and reporting multivariable-adjusted hazard ratios (HRs) for mortality or heart failure hospitalisation in relation to CMR-derived ECV were included. Random-effects inverse-variance meta-analysis was performed on the log (HR) scale to accommodate heterogeneous ECV scaling. Sensitivity and dose–response analyses were conducted.Results Five observational cohorts comprising 771 HFpEF patients were included. Participants were predominantly older adults (mean age 68–78 years), with a slight female predominance, reflecting real-world HFpEF populations. Across studies, higher myocardial ECV was consistently associated with worse clinical outcomes. In the primary pooled analysis, increased ECV conferred a 24% higher risk of death or heart failure hospitalisation (pooled HR 1.24, 95% CI 1.07–1.44; p=0.0039). In homogeneous per–1% ECV analyses, each 1% increment in ECV was associated with a 7% increase in risk (I 2=0%). Dose–response modelling demonstrated a graded relationship, with a 5% rise in ECV associated with a 54% increase in risk and a 10% increase nearly doubling the risk.Conclusion In HFpEF, CMR-derived ECV provides powerful, non-invasive, dose-dependent prognostic stratification, with even a modest increase identifying patients at substantially higher risk. These newly emerging findings support the incorporation of CMR tissue characterisation into HFpEF risk assessment and trial enrichment strategies.",
  "authors": [
    {
      "affiliations": [
        "University Hospital North Tees and Hartlepool, Stockton on Tees, United Kingdom"
      ],
      "name": "Khalid Rashid"
    },
    {
      "affiliations": [
        "University Hospital North Tees and Hartlepool, Stockton on Tees, United Kingdom"
      ],
      "name": "Arshad Khan"
    },
    {
      "affiliations": [
        "Alkhidmat Raazi Hospital, Rawalpindi, Pakistan"
      ],
      "name": "Farrukh Ansar"
    },
    {
      "affiliations": [
        "Oxford University Hospitals NHS, Oxford, United Kingdom"
      ],
      "name": "Mustafa Javaid"
    },
    {
      "affiliations": [
        "Hamad General Hospital, Doha, Qatar"
      ],
      "name": "Muhammad Aamir Waheed"
    },
    {
      "affiliations": [
        "University Hospital North Tees and Hartlepool, Stockton on Tees, United Kingdom"
      ],
      "name": "Mubammad Ali Hafeez"
    },
    {
      "affiliations": [
        "Glenfield Hospital, University Hospital of Leicester NHS Trust, Leicester, United Kingdom"
      ],
      "name": "Abdulrahman Kolapo"
    }
  ],
  "title": "65 Cardiac magnetic resonance–derived extracellular volume provides powerful prognostic stratification in heart failure with preserved ejection fraction: a meta-analysis",
  "uid": "7e1593ee-8131-5a61-9d32-271261840f39"
}