Myocardial fibrosis

Heart failure with preserved ejection fraction

Ventricular remodeling

Fibrosis

Cardiology

Heart failure

Idiopathic pulmonary fibrosis

Internal medicine

Medicine

Ejection fraction

Lung

Pirfenidone

Abstracts

<h3>Objectives</h3> To identify baseline characteristics that associate with baseline myocardial fibrotic burden, predict change in myocardial fibrosis over a year, and predict response to the novel anti-fibrotic agent, pirfenidone, in patients with heart failure with preserved ejection fraction (HFpEF). <h3>Background</h3> Myocardial fibrosis, measured using cardiovascular magnetic resonance extracellular volume (ECV), is associated with adverse outcome in HFpEF. In the PIROUETTE (The Pirfenidone in Patients with Heart Failure and Preserved Left Ventricular Ejection Fraction) trial, pirfenidone reduced myocardial fibrosis. <h3>Methods</h3> Amongst patients enrolled in the PIROUETTE trial (n=107), linear regression models were used to assess the relationship between baseline variables and baseline myocardial ECV, and with change in myocardial ECV (week 52 value minus baseline value), adjusting for treatment allocation. Linear regression models were used to identify baseline variables that modified pirfenidone treatment effect. <h3>Results</h3> Body mass index, left atrial reservoir strain, haemoglobin and aortic distensibility were associated with baseline ECV in stepwise modelling (table 1). QRS duration, left ventricular mass and presence of an infarct at baseline were associated with an increase in ECV from baseline to week 52 in stepwise modelling. Whilst QRS duration, presence of an infarct, global longitudinal strain and left atrial strain modified the treatment effect of pirfenidone when considered individually, no baseline variable modified treatment effect on multivariable modelling. <h3>Conclusions</h3> Baseline characteristics were identified that associate with myocardial fibrosis and can predict change in myocardial fibrosis over 1 year. No variables that independently modify the treatment effect of pirfenidone were identified (PIROUETTE, NCT02932566).

7 Predictors of myocardial fibrosis and response to anti-fibrotic therapy in heart failure with preserved ejection fraction