CMR-based cardiac phenotyping in different forms of heart failure

• Published in: The international journal of cardiovascular imaging Vol. 40; no. 7; pp. 1585 - 1596
• Main Authors: Lange, Torben, Backhaus, Sören J., Schulz, Alexander, Hashemi, Djawid, Evertz, Ruben, Kowallick, Johannes T., Hasenfuß, Gerd, Kelle, Sebastian, Schuster, Andreas
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.07.2024; Springer Nature B.V
• Subjects: Cardiac Imaging; Cardiology; Congestive heart failure; Coronary artery disease; Fibrosis; Gadolinium; Heart diseases; Heart failure; Imaging; Impairment; Magnetic resonance; Magnetic resonance imaging; Mapping; Medical imaging; Medicine; Medicine & Public Health; Original Paper; Phenotypes; Phenotyping; Radiology; Structural analysis; Structure-function relationships; Ventricle; Heart failure; CMR imaging; Left atrioventricular coupling index; CMR-based tissue characterization; CMR feature-tracking; Myocardial strain assessment
• ISSN: 1875-8312; 1569-5794; 1875-8312; 1573-0743
• DOI: 10.1007/s10554-024-03145-4

Heart failure (HF) is a heterogenous disease requiring precise diagnostics and knowledge of pathophysiological processes. Since structural and functional imaging data are scarce we hypothesized that cardiac magnetic resonance (CMR)-based analyses would provide accurate characterization and mechanistic insights into different HF groups comprising preserved (HFpEF), mid-range (HFmrEF) and reduced ejection fraction (HFrEF). 22 HFpEF, 17 HFmrEF and 15 HFrEF patients as well as 19 healthy volunteers were included. CMR image assessment contained left atrial (LA) and left ventricular (LV) volumetric evaluation as well as left atrioventricular coupling index (LACI). Furthermore, CMR feature-tracking included LV and LA strain in terms of reservoir (Es), conduit (Ee) and active boosterpump (Ea) function. CMR-based tissue characterization comprised T1 mapping as well as late-gadolinium enhancement (LGE) analyses. HFpEF patients showed predominant atrial impairment (Es 20.8%vs.25.4%, p = 0.02 and Ee 8.3%vs.13.5%, p = 0.001) and increased LACI compared to healthy controls (14.5%vs.23.3%, p = 0.004). Patients with HFmrEF showed LV enlargement but mostly preserved LA function with a compensatory increase in LA boosterpump (LA Ea: 15.0%, p = 0.049). In HFrEF LA and LV functional impairment was documented (Es: 14.2%, Ee: 5.4% p < 0.001 respectively; Ea: 8.8%, p = 0.02). This was paralleled by non-invasively assessed progressive fibrosis (T1 mapping and LGE; HFrEF > HFmrEF > HFpEF). CMR-imaging reveals insights into HF phenotypes with mainly atrial affection in HFpEF, ventricular affection with atrial compensation in HFmrEF and global impairment in HFrEF paralleled by progressive LV fibrosis. These data suggest a necessity for a personalized HF management based on imaging findings for future optimized patient management.