Miscellaneous
Anders Nelsson, MD
MD, PhD student
Lund University, Skåne University Hospital, Sweden
Anders Nelsson, MD
MD, PhD student
Lund University, Skåne University Hospital, Sweden
Per M. Arvidsson, MD, PhD
Researcher
University of Oxford, Sweden
Jonathan Edlund, MD
MD
Lund University, Skåne University Hospital
Lund, Skane Lan, Sweden
Martin Magnusson, MD, PhD
Professor
Lund University, Skåne University Hospital
Malmö, Skane Lan, Sweden
Gustav Smith, MD, PhD
Professor
Lund University, Skåne University Hospital, Sweden
Katarina Steding-Ehrenborg, PhD
Associate Professor
Lund University, Skane University Hospital
Lund, Skane Lan, Sweden
Håkan Arheden, MD, PhD
Professor
Lund University
Lund, Sweden
Pulmonary congestion may manifest as increased pulmonary blood volume (PBV), which can be estimated from the product of cardiac output and pulmonary transit-time (PTT) as determined by cardiovascular magnetic resonance (CMR)1. While increased PBV is a negative prognostic marker in heart failure outpatients with reduced ejection fraction (HFrEF)2, PBV has not been investigated in heart failure outpatients with preserved (HFpEF) or mildly reduced ejection fraction (HFmrEF) . It is also unknown if patients with HFrEF have an increased PBV after subtraction of left atrial volume (LAV)3. Therefore, the aim of this study was to evaluate if PBV differs between heart failure patients with HFpEF, HFmrEF or HFrEF compared to controls and to evaluate if adjustment for the LAV makes a difference when comparing patients with heart failure to controls.
Methods:
We studied 16 controls, 16 patients with HFrEF (ejection fraction < 40%), 9 with HFmrEF (ejection fraction 40-49%) and 16 patients with HFpEF (ejection fraction >50%). All heart failure patients were stable outpatients. Controls were age-matched to the group of heart failure patients, but patients with HFpEF were older than controls (median 62 and 73 years respectively). All subjects underwent 1.5T CMR, acquiring aortic 2D flow for cardiac output and first-pass perfusion to measure PTT. Short-axis cine stacks were used to measure the LAV, including the appendage. PBV was calculated with and without subtraction of the LAV and subsequently indexed to body surface area. Comparisons for each HF phenotype with controls were performed using pairwise Mann-Whitney U tests. Statistical significance was assigned at p< 0.05. Results are shown in medians.
Results: Figure 1 shows that when including the LAV, the PBV was significantly increased for HFrEF (373 ml/m2, p< 0.001) and nominally increased in HFmrEF (370 ml/m2, p=0.14) or in HFpEF (343 ml/m2, p=0.13) compared to controls (303 ml/m2). When excluding the LAV, differences in PBV were markedly attenuated for HFrEF (302 ml/m2, p=0.03), HFmrEF (338 ml/m2, p=0.17) or HFpEF (296 ml/m2, p=0.45) compared to controls (273 ml/m2).
Conclusion:
Differences in PBV between healthy controls and outpatients with HF were most pronounced in HFrEF, perhaps reflecting larger disease severity in this group, but were small when excluding LAV. PBV may be of larger value in patients with decompensated HF.