# Left ventricular diastolic volume on cardiac magnetic resonance and risk of incident heart failure

## TL;DR

This study shows that both very high and very low left ventricular diastolic volumes are linked to a higher risk of developing heart failure, with effects differing based on heart ejection fraction and sex.

## Contribution

The study reveals a U-shaped relationship between indexed left ventricular end-diastolic volume and heart failure risk, modified by ejection fraction and sex.

## Key findings

- Indexed left ventricular end-diastolic volume (iLVEDV) shows a U-shaped association with incident heart failure.
- Higher risk of heart failure is observed in patients with iLVEDV > 100 mL/m² or <45 mL/m².
- The relationship between iLVEDV and heart failure risk is modified by left ventricular ejection fraction (LVEF).

## Abstract

We explored the association between indexed left ventricular end-diastolic volume (iLVEDV) on cardiac magnetic resonance (CMR) and the risk of incident heart failure (HF) (stage C) in patients with suspected coronary heart disease without overt HF (stages A and B). We also examined the risk-modifying effect of left ventricular ejection fraction (LVEF) and sex.

We retrospectively included 5471 patients who underwent vasodilator stress CMR for suspected coronary artery disease and without a history of HF. Multivariate Cox proportional hazards regression adapted for competing events models assessed the relationship between iLVEDV and new-onset HF (stage C), considering LVEF status as a potential modifier. The mean age was 651 ± 11.6 years, and 2123 (38.8%) were women. The medians of CMR-iLVEDV and CMR-LVEF were 67 mL/m2 (55–80) and 66% (58–72), respectively. At a median (p25% to p75%) follow-up of 5.1 years (2.3–8.2), we registered 287 new-onset HF diagnosis. iLVEDV was associated with a U-shaped risk of incident HF. The risk was most pronounced with an iLVEDV > 100 mL/m2 and <45 mL/m2. Notably, the association between iLVEDV and HF risk was influenced by LVEF status. In patients with LVEF < 50%, a higher risk was found in those with larger iLVEDV. On the contrary, LVEF > 60%, lower iLVEDV identified those at increased risk.

In subjects with higher LVEF, smaller left ventricle volumes identified a subset of patients with an increased risk of incident HF. These findings reveal a need for a better understanding of the pathophysiological mechanisms of HF with supranormal ejection fraction.

Graphical AbstractLeft ventricular diastolic volume and risk of new-onset HF.HF: heart failure; iLVEDV: indexed left ventricle end-diastolic volume; LVEF: left ventricle ejection fraction; CMR: magnetic resonance.

Left ventricular diastolic volume and risk of new-onset HF.

HF: heart failure; iLVEDV: indexed left ventricle end-diastolic volume; LVEF: left ventricle ejection fraction; CMR: magnetic resonance.