Insights Into Myocardial Oxygenation and Cardiovascular Magnetic Resonance Tissue Biomarkers in Heart Failure With Preserved Ejection Fraction.

Fischer, Kady; Guensch, Dominik P.; Jung, Bernd; King, Iman; von Tengg-Kobligk, Hendrik; Giannetti, Nadia; Eberle, Balthasar; Friedrich, Matthias G (2022). Insights Into Myocardial Oxygenation and Cardiovascular Magnetic Resonance Tissue Biomarkers in Heart Failure With Preserved Ejection Fraction. Circulation. Heart failure, 15(4), e008903. American Heart Association 10.1161/CIRCHEARTFAILURE.121.008903

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BACKGROUND

The pathophysiology of heart failure with preserved ejection fraction is not well understood, but evidence strongly suggests involvement of microvascular dysfunction. We studied the myocardial oxygenation reserve as a direct marker of coronary vascular function and its relation to myocardial deformation and tissue characteristics by cardiovascular magnetic resonance (CMR).

METHODS

In a dual-center case-control study, patients with heart failure and preserved ejection fraction (>50%) and healthy controls older than 50 years underwent quantitative CMR for ventricular volumes and functional assessment with feature tracking, as well as tissue characterization (T1, T2, extracellular volume). Coronary vascular function was measured by oxygenation-sensitive (OS)-CMR of the myocardial oxygenation response to a vasoactive breathing maneuver.

RESULTS

Twenty-nine patients completed the CMR exam. Compared with cutoffs derived from 12 control subjects, circumferential peak strain was attenuated in 97% of patients. Native T1 was elevated in 93%, extracellular volume was elevated in 83%. Sixty-six percent of patients revealed either regional or global myocardial edema, defined by an increased myocardial T2. An attenuated global myocardial oxygenation reserve (<4.4%) was observed in 96% of the patients (1.7±3.9% versus 9.1±5.3% in controls, P<0.001). This was correlated with septal wall thickness (r=-0.54, P=0.003), edema (myocardial T2; β=-0.26% oxygenation-sensitive/ms [95% CI, -0.49 to -0.03], P=0.029), and reduced diastolic strain rate (β=1.50% oxygenation-sensitive/s-1 [95% CI, 0.06-2.90], P=0.042).

CONCLUSIONS

In patients with clinical heart failure with preserved ejection fraction, vascular dysfunction as measured by an attenuated myocardial oxygenation reserve is associated with myocardial edema, a thicker septum, and diastolic dysfunction. A quantitative comprehensive CMR exam including oxygenation-sensitive-CMR allows for comprehensive imaging-based phenotyping of heart failure with preserved ejection fraction.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Fischer, Kady Anne, Günsch, Dominik, Jung, Bernd, von Tengg-Kobligk, Hendrik, Eberle, Balthasar

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1941-3297

Publisher:

American Heart Association

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

07 Feb 2022 08:52

Last Modified:

05 Dec 2022 16:04

Publisher DOI:

10.1161/CIRCHEARTFAILURE.121.008903

PubMed ID:

35038887

Uncontrolled Keywords:

coronary artery disease edema heart failure magnetic resonance imaging oxygen

BORIS DOI:

10.48350/164598

URI:

https://boris.unibe.ch/id/eprint/164598

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