CMR-Analysis (including machine learning)
Djawid Hashemi, MD
Physician / Clinician Scientist
Charité – Universitätsmedizin Berlin
Berlin, Berlin, Germany
Djawid Hashemi, MD
Physician / Clinician Scientist
Charité – Universitätsmedizin Berlin
Berlin, Berlin, Germany
Patrick Doeblin, MD
Cardiologist
German Heart Center Charité, Germany
Moritz Blum, MD
Resident
Charité – Universitätsmedizin Berlin, New York, Germany
Karl Jakob Weiss, MD
Physician
German Heart Center of the Charité
Berlin, Berlin, Germany
Matthias Schneider, MD
Physician
Charité – Universitätsmedizin Berlin, Berlin, Germany
Grigorios Korosoglou, MD
Professor
Charité - Universitätsmedizin Berlin, Baden-Wurttemberg, Germany
Rebecca Elisabeth Beyer, MD
Resident
Charité & German Cardiac centere, Germany
Burkert Pieske, MD
Head of Departement
Charité – Universitätsmedizin Berlin, Berlin, Germany
Frank Edelmann, MD
Physician
Charité – Universitätsmedizin Berlin, Berlin, Germany
Sebastian Kelle, MD, FSCMR
Cardiologist
German Heart Center Berlin
Berlin, Berlin, Germany
Heart failure with preserved ejection fraction (HFpEF) is defined as symptomatic heart failure (HF), a left ventricular ejection fraction (LVEF) ≥ 50% and evidence of diastolic dysfunction and/or raised LV filling pressures.1 HFpEF is associated with a variety of cardiovascular (CV) risk factors and a high risk for both mortality and recurrent HF hospitalization.2, 3 Regional strain assessment by CMR seems to be superior to global strain analysis in describing deformation impairment in HF.4 The MyoHealth score reflects the share of LV segments with preserved strain values (≤-17%) in a 37 segment model.4
Methods:
This study was a prospective study conducted in Berlin, Germany. Its rationale and design have been described previously.5
Briefly, HF patients irrespective of LVEF and asymptomatic controls were recruited, and CMR based measures were obtained. For this analysis, we included the control subjects and the HFpEF patients.
For this analysis the asymptomatic control group (n=19) was divided into asymptomatic subjects without CV co-morbidities) or evidence of cardiac abnormalities and (n=12) and asymptomatic subjects with CV co-morbidities or evidence of cardiac abnomalities (n=7). We performed CMR scans at rest and during a stress test using isometric handgrip exercise (HG).6
The groups were compared using a student’s t-test. A P-value < 0.05 was considered statistically significant.
The endpoint was the MyoHealth score at rest and under handgrip stress (HG).
Results:
The LVEF was similar in all three cohorts: LVEF mean ± standard deviation (SD): control: 62±5% (n=12); At risk: 61±6% (n=7); HFpEF: 61±6% (n=19).
Assessing the MyoHealth score at rest revealed preserved regional strain in 85±9% of LV segments in controls, 73±11% in At Risk subjects and 73±8% in HFpEF patients (comparisons in Figure A). During stress the MyoHealth score was 84±7% in controls, 83±7 in At Risk subjects and 74±11 in HFpEF patients (comparisons in Figure B).
At rest, the MyoHealth score in the at-risk cohort was reduced compared to the healthy controls , at the same level as the HFpEF cohort. This is in line with our recent finding that demonstrated the potential diagnostic window across different heart-failure stages using CMR-strain-analysis.7 However, during stress, the at-risk cohort showed a higher MyoHealth score and was similar to the healthy controls and higher than the HFpEF values. The ‘at risk’ group improved significantly between rest and stress (Figure A and B), while there were no relevant changes in healthy controls or HFpEF.
Conclusion:
In summary, we show for the first time that asymptomatic subjects with evidence of CV risk present with HFpEF like impaired myocardial deformation at rest. The absence of HF symptoms in these subjects is well explained by the compensation capacities during stress when their deformation capacities are similar to healthy subjects.
The potential of preventive treatment in this group of patients merits further investigation in future studies.