1
Karl Jakob Weiss, MD
Physician
German Heart Center of the Charité
Berlin, Berlin, Germany
Karl Jakob Weiss, MD
Physician
German Heart Center of the Charité
Berlin, Berlin, Germany
Djawid Hashemi, MD
Physician / Clinician Scientist
Charité – Universitätsmedizin Berlin
Berlin, Berlin, Germany
Patrick Doeblin, MD
Cardiologist
German Heart Center Charité, Germany
Rebecca Beyer, MD
Physician
German Heart Center Berlin
Berlin, Berlin, Germany
Alex Tuit
Medical Technologist
German Heart Center Berlin, Berlin, Germany
Moritz Blum, MD
Resident
Charité – Universitätsmedizin Berlin, New York, Germany
Radu Tanacli, MD
Research Fellow
German Heart Center Berlin
Berlin, Berlin, Germany
Matthias Schneider, MD
Physician
Charité – Universitätsmedizin Berlin, Berlin, Germany
Christian Stehning, PhD
MRI Physicist
Philips Healthcare, Hamburg, Germany
Hans-Dirk Duengen, MD
Physician
Charité – Universitätsmedizin Berlin, Berlin, Germany
Frank Edelmann, MD
Physician
Charité – Universitätsmedizin Berlin, Berlin, Germany
Burkert Pieske, MD
Head of Departement
Charité – Universitätsmedizin Berlin, Berlin, Germany
Titus Kuehne, MD
Physician
German Heart Center Berlin, Germany
Marcus Kelm, MD
Physician
German Heart Center Berlin, Berlin, Germany
Sebastian Kelle, MD, FSCMR
Cardiologist
German Heart Center Berlin
Berlin, Berlin, Germany
Volume overload and fluid congestion are essential signs of heart failure (HF), and restoring a euvolemic state is one of the pillars of treatment for HF patients. Independent from fluid status, tissue sodium has emerged as a potentially confounding factor in HF patients and might become a potential treatment target in the future.(1,2) The development of 23Na- Magnet resonance imaging (MRI) enables the quantification of sodium in the skin and muscle of humans non-invasively. To date, tissue sodium has only been investigated in patients with heart failure with reduced left ventricular ejection fraction (HFrEF). Its role in patients with mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF) is unclear.
Methods:
At a 3.0 T Philips Ingenia scanner, 29 stable HF patients underwent cardiac magnetic resonance (CMR) imaging and 23Na-MRI, using a 23Na send/receive knee coil (Rapid Biomedical, Rimpar, Germany) with a 2D-spoiled gradient echo together with four phantoms containing calibration solutions of 10, 20, 30, and 40 mmol/L NaC as previously described (Figure 1).(3) HFrEF was defined as signs and symptoms of HF and a left ventricular ejection fraction (LVEF) of < 40%, HFmrEF as LVEF 40-49%, and HFpEF as LVEF ≥ 50%.(4) Statistical significance was assumed at p < 0.05.
Results:
The ratio of skin sodium/muscle sodium differs among entities of HF patients [Figure 2, H(2) = 8.26; p = 0.04]. Conversely, skin sodium content (p = 0.4) or muscle sodium content (p = 0.2) alone did not differ significantly. No significant differences regarding serum electrolytes, N-terminal pro brain natriuretic peptide (NT-ProBNP), or kidney function were found among HF patients (Table 1).
Conclusion:
Non-invasive 23Na- MRI allows discrimination of HF entities by assessment of the skin/muscle sodium ratio. This finding is in line with the growing appreciation of tissue sodium in HF patients.(2) Of note, all patients were in a stabilized state and expressing similar levels of NT- ProBNP, possibly explaining the similarities for skin sodium and muscle sodium alone.(1) Further research is essential for a deeper understanding of the pathophysiologic background of the distinct sodium accumulation patterns among HF entities.