Sex-Specific Impairment of Cardiac Functional Reserve in HFpEF

Schulz, Alexander; Lange, Torben; Evertz, Ruben; Kowallick, Johannes T.; Hasenfuß, Gerd; Backhaus, Sören J.; Schuster, Andreas

doi:10.1016/j.jacadv.2023.100327

Cited by 7 publications

(3 citation statements)

References 54 publications

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“…CMR-FT derived LV GLS has been shown to correlate with invasively assessed LV relaxation Tau [ 28 ] and is associated with heart failure hospitalisation and mortality [ 29 ]. LA function has also been shown to be a sensitive imaging-biomarker for cardiac remodelling in HFpEF [ 30 , 31 ] independent of atrial size [ 32 ] and associated with cardiovascular outcome [ 33 ]. CMR-FT atrial assessments offer differentiation of the three phases of atrial physiology, which can be attributed to atrial elasticity (reservoir and to some extent conduit function) and function parameters that contribute to LV filling (booster pump and to some extent conduit function) [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Real-time cardiovascular magnetic resonance imaging for non-invasive characterisation of heart failure with preserved ejection fraction: final outcomes of the HFpEF stress trial

Backhaus,

Schulz,

Lange

et al. 2024

Clin Res Cardiol

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Background The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. Recently, the HFpEF Stress Trial demonstrated feasibility and accuracy of non-invasive cardiovascular magnetic resonance (CMR) real-time (RT) exercise-stress atrial function imaging for early identification of HFpEF. However, no outcome data have yet been presented. Methods The HFpEF Stress Trial (DZHK-17) prospectively recruited 75 patients with dyspnea on exertion and echocardiographic preserved EF and signs of diastolic dysfunction (E/eʹ > 8). 68 patients entered the final study cohort and were characterized as HFpEF (n = 34) or non-cardiac dyspnea (n = 34) according to pulmonary capillary wedge pressure (HFpEF: PCWP rest: ≥ 15 mmHg stress: ≥ 25 mmHg). These patients were contacted by telephone and hospital charts were reviewed. The clinical endpoint was cardiovascular events (CVE). Results Follow-up was performed after 48 months; 1 patient was lost to follow-up. HFpEF patients were more frequently compared to non-cardiac dyspnea (15 vs. 8, p = 0.059). Hospitalised patients during follow-up had higher H2FPEF scores (5 vs. 3, p < 0.001), and impaired left atrial (LA) function at rest (p ≤ 0.002) and stress (p ≤ 0.006). Impairment of CMR-derived atrial function parameters at rest and during exercise-stress (p ≤ 0.003) was associated with increased likelihood for CVE. CMR-Feature Tracking LA Es/Ee (p = 0.016/0.017) and RT-CMR derived LA long axis strain (p = 0.003) were predictors of CVE independent of the presence of atrial fibrillation. Conclusions Left atrial function emerged as the strongest predictor for 4-year outcome in the HFpEF Stress Trial. A combination of rest and exercise-stress LA function quantification allows accurate diagnostic and prognostic stratification in HFpEF. Clinicaltrials.gov: NCT03260621. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Real-time cardiovascular magnetic resonance imaging for non-invasive characterisation of heart failure with preserved ejection fraction: final outcomes of the HFpEF stress trial

Backhaus,

Schulz,

Lange

et al. 2024

Clin Res Cardiol

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“…In this issue of JACC: Advances , Schulz et al 7 provide new insight into sex-specific impairments in cardiac reserve in HFpEF. This was a secondary analysis of 68 patients who underwent a sophisticated exercise cardiac magnetic resonance imaging and catheterization protocol with the diagnosis of HFpEF definitively established by an elevated PCWP at rest or exercise.…”

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“…Weight loss results in improvement in pericardial restraint and hemodynamics in obese patients without heart failure, 12 but its impact on LA function is less clear, 13 and further study of weight loss in female patients with HFpEF with obesity is urgently needed. The study by Schulz et al 7 remind us that differences in the way men and women’s hearts respond to exercise in HFpEF may well prove to have critical therapeutic impact for current and future therapies being tested in clinical trials.…”

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High Filling Pressures in HFpEF

Reddy

2023

JACC: Advances

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Assessment of the cardiac output at rest and during exercise stress using real-time cardiovascular magnetic resonance imaging in HFpEF-patients

Schulz,

Mittelmeier,

Wagenhofer

et al. 2024

Int J Cardiovasc Imaging

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This methodological study aimed to validate the cardiac output (CO) measured by exercise-stress real-time phase-contrast cardiovascular magnetic resonance imaging (CMR) in patients with heart failure and preserved ejection fraction (HFpEF). 68 patients with dyspnea on exertion (NYHA ≥ II) and echocardiographic signs of diastolic dysfunction underwent rest and exercise stress right heart catheterization (RHC) and CMR within 24 h. Patients were diagnosed as overt HFpEF (pulmonary capillary wedge pressure (PCWP) ≥ 15mmHg at rest), masked HFpEF (PCWP ≥ 25mmHg during exercise stress but < 15mmHg at rest) and non-cardiac dyspnea. CO was calculated using RHC as the reference standard, and in CMR by the volumetric stroke volume, conventional phase-contrast and rest and stress real-time phase-contrast imaging. At rest, the CMR based CO showed good agreement with RHC with an ICC of 0.772 for conventional phase-contrast, and 0.872 for real-time phase-contrast measurements. During exercise stress, the agreement of real-time CMR and RHC was good with an ICC of 0.805. Real-time measurements underestimated the CO at rest (Bias:0.71 L/min) and during exercise stress (Bias:1.4 L/min). Patients with overt HFpEF had a significantly lower cardiac index compared to patients with masked HFpEF and with non-cardiac dyspnea during exercise stress, but not at rest. Real-time phase-contrast CO can be assessed with good agreement with the invasive reference standard at rest and during exercise stress. While moderate underestimation of the CO needs to be considered with non-invasive testing, the CO using real-time CMR provides useful clinical information and could help to avoid unnecessary invasive procedures in HFpEF patients.

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Sex-Specific Impairment of Cardiac Functional Reserve in HFpEF

Cited by 7 publications

References 54 publications

Real-time cardiovascular magnetic resonance imaging for non-invasive characterisation of heart failure with preserved ejection fraction: final outcomes of the HFpEF stress trial

Real-time cardiovascular magnetic resonance imaging for non-invasive characterisation of heart failure with preserved ejection fraction: final outcomes of the HFpEF stress trial

High Filling Pressures in HFpEF

Assessment of the cardiac output at rest and during exercise stress using real-time cardiovascular magnetic resonance imaging in HFpEF-patients

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