CMR Tissue Characterization in Patients with HFmrEF

Patrick Doeblin, Djawid Hashemi, Radu Tanacli, Tomas Lapinskas, Rolf Gebker, Christian Stehning, Laura Astrid Motzkus, Moritz Blum, Elvis Tahirovic, Aleksandar Dordevic, Robin Kraft, Seyedeh Mahsa Zamani, Burkert Pieske, Frank Edelmann, Hans-Dirk Düngen, Sebastian Kelle, Patrick Doeblin, Djawid Hashemi, Radu Tanacli, Tomas Lapinskas, Rolf Gebker, Christian Stehning, Laura Astrid Motzkus, Moritz Blum, Elvis Tahirovic, Aleksandar Dordevic, Robin Kraft, Seyedeh Mahsa Zamani, Burkert Pieske, Frank Edelmann, Hans-Dirk Düngen, Sebastian Kelle

Abstract

The characteristics and optimal management of heart failure with a moderately reduced ejection fraction (HFmrEF, LV-EF 40-50%) are still unclear. Advanced cardiac MRI offers information about function, fibrosis and inflammation of the myocardium, and might help to characterize HFmrEF in terms of adverse cardiac remodeling. We, therefore, examined 17 patients with HFpEF, 18 with HFmrEF, 17 with HFrEF and 17 healthy, age-matched controls with cardiac MRI (Phillips 1.5 T). T1 and T2 relaxation time mapping was performed and the extracellular volume (ECV) was calculated. Global circumferential (GCS) and longitudinal strain (GLS) were derived from cine images. GLS (-15.7 ± 2.1) and GCS (-19.9 ± 4.1) were moderately reduced in HFmrEF, resembling systolic dysfunction. Native T1 relaxation times were elevated in HFmrEF (1027 ± 40 ms) and HFrEF (1033 ± 54 ms) compared to healthy controls (972 ± 31 ms) and HFpEF (985 ± 32 ms). T2 relaxation times were elevated in HFmrEF (55.4 ± 3.4 ms) and HFrEF (56.0 ± 6.0 ms) compared to healthy controls (50.6 ± 2.1 ms). Differences in ECV did not reach statistical significance. HFmrEF differs from healthy controls and shares similarities with HFrEF in cardiac MRI parameters of fibrosis and inflammation.

Keywords: ECV, fibrosis; HFmrEF; T1 mapping; T2 mapping; inflammation; strain.

Conflict of interest statement

P.D. received a travel grant from Biotronic and owns stock of Siemens AG and Bayer AG. P.D., D.H., T.L., S.K., F.E., H.-D.D. and B.P. received support from the DZHK (German Centre for Cardiovascular Research). C.S. is an employee of Philips Healthcare. B.P. has received advisory board and lecture honoraria from Bayer Healthcare, Novartis, Merck Sharp and Dohme, Stealth Peptides, Sanofi and Servier. F.E. has received advisory board and lecture honoraria from Boehringer Ingelheim, Bayer Healthcare, Novartis, Merck Sharp and Dohme, Vifor, and Servier. H.-D.D. received advisory board honoraria from Bayer, Novartis, Stealt and Berlin Cures. S.K. was supported by an unrestricted research grant from Philips Health Care. All other authors declare that they have no financial or non-financial competing interest to disclose.

Figures

Figure 1
Figure 1
Exemplary medial short axis images of T2 relaxation time maps (first row, (A–D)), T1 relaxation time maps (second row, E–H) and extracellular volume (ECV) maps (third row, (I–L)). First column (A,E,I): Healthy control (ECV image from a patient from clinical routine, as no contrast agent was given to healthy controls in our study). Second column (B,F,J): Patient number 3 (HFpEF). Third column (C,G,K): Patient number 9 (HFmrEF). Fourth column (D,H,L): Patient number 11 (HFrEF). Segments with scars excluded from analysis. ECV = Extracellular volume. HFmrEF = Heart failure with moderately reduced Ejection fraction, HFpEF = Heart failure with preserved ejection fraction, HFrEF = Heart failure with reduced ejection fraction.
Figure 2
Figure 2
Boxplots of heart failure groups and controls versus (A) T2 relaxation time, (B) Native T1 relaxation time, (C) ECV (controls from Dabir et al. 2014) [14], (D) GLS, (E) GCS and (F) strain ratio (GLS/GCS). * Significant at α = 0.05. ** Significant at α = 0.01. n.s. = not significant at 0.05. GCS = global circumferential strain, GLS = global longitudinal strain. Other abbreviations as in Figure 1.
Figure 3
Figure 3
Scatter Plots and linear model parameters of T2 relaxation time versus (A) NT-proBNP (logarithmic scale), (B) glomerular filtration rate (GFR) and (C) 6 min walking test. (D) Scatter plot and Spearman’s correlation coefficient of T2 relaxation time versus quality of life, as assessed by the Minnesota Living with Heart Failure Questionnaire.

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