Tissue Characterization
Wasim Javed, MBChB, MRes
Cardiology Clinical Research Fellow/ Registrar
Leeds Institute of Cardiovascular and Metabolic Medicine, United Kingdom
Ze Ming Goh
Academic Foundation Doctor
University of Leeds, England, United Kingdom
Mubien Shabi
Cardiology Imaging Fellow
University of Leeds, United Kingdom
Joel R. Klassen
Academic Doctor
University of Leeds
York, England, United Kingdom
Erica Dall’Armellina
Associate Professor and Honorary Consultant Cardiologist
University of Leeds, England, United Kingdom
Eylem Levelt, PhD
Associate Professor and Honorary Consultant
University of Leeds
Leeds, England, United Kingdom
Hui Xue, PhD
Director, Imaging AI Program
National Institutes of Health
Bethesda, Maryland, United States
Peter Kellman, PhD
Senior Scientist
National Institutes of Health, Maryland, United States
John P. Greenwood, PhD
Professor
University of Leeds
Leeds, England, United Kingdom
Sven Plein, MD, PhD
Professor
University of Leeds
Leeds, England, United Kingdom
Peter P. Swoboda, PhD
Consultant Cardiologist & Senior Lecturer
University of Leeds
Leeds, England, United Kingdom
Patients with heart failure with recovered ejection fraction (HFrecEF), despite improvement of left ventricular ejection fraction (LVEF), have increased cardiac risk. A recent American College of Cardiology Scientific Expert panel has highlighted a need for improved understanding of the mechanisms of HFrecEF1. We therefore aimed to determine which cardiovascular magnetic resonance (CMR) myocardial tissue characteristics are associated with HFrecEF.
Methods:
We prospectively recruited patients who were recently diagnosed with LVEF ≤40% on echocardiography and underwent CMR. The exclusion criteria included history of coronary artery disease ( >70% stenosis on invasive coronary angiography), myocardial infarction, coronary revascularisation, or anginal symptoms. Guideline-directed therapy was started after HFrEF diagnosis on echocardiography. Comprehensive CMR assessment included late gadolinium enhancement (LGE), pre and post contrast T1 mapping, T2 maping and quantitative stress-perfusion study. HFrecEF was defined as LVEF of >40% with ≥10% of absolute improvement from baseline on CMR assessment. T-test and Chi-squared test were used to compare demographic, clinical, echocardiographic and CMR variables between the group of patients who recovered and the group of patients who failed to. Logistic regression was used to identify variables that were associated with the recovery of LVEF.
Results:
A total of 343 patients with HFrEF were diagnosed on echocardiography, 117 (34%) attained HFrecEF with guideline-based therapy at subsequent CMR assessment (median 63 days, 40 – 117 days). Younger age and female sex were associated with recovery of LVEF. Patients with HFrecEF had higher baseline LVEF, higher stress and rest myocardial blood flow (MBF), lower native T1 time, lower extracellular volume (ECV) and lower prevalence of unrecognised ischaemic fibrosis. There was no significant difference in guideline-directed therapy between the two groups of patients, but patients with HFrecEF were less likely to receive diuretics (Table 1). At multivariate logistic regression, gender, baseline LVEF, ischaemic LGE, native T1 relaxation time, and stress MBF were independently associated with LVEF recovery (Table 2).
Conclusion:
Patients with HFrecEF have altered myocardial tissue characteristics on CMR including lower native T1, lower ECV and higher MBF at both stress and rest. Future studies are needed to establish whether these parameters can be used to risk stratify patients with HFrecEF.