Abstract
To assess whether a simplified cardiac magnetic resonance (CMR)–derived lung water density (LWD) quantification predicted major events in Heart Failure (HF). Single-centre retrospective study of consecutive HF patients with left ventricular ejection fraction (LVEF) < 50% who underwent CMR. All measurements were performed on HASTE sequences in a parasagittal plane at the right midclavicular line. LWD was determined by the lung-to-liver signal ratio multiplied by 0.7. A cohort of 102 controls was used to derive the LWD upper limit of normal (21.2%). The primary endpoint was a composite of time to all-cause death or HF hospitalization. Overall, 290 patients (mean age 64 ± 12 years) were included. LWD measurements took on average 35 ± 4 s, with good inter-observer reproducibility. LWD was increased in 65 (22.4%) patients, who were more symptomatic (NYHA ≥ III 29.2 vs. 1.8%; p = 0.017) and had higher NT-proBNP levels [1973 (IQR: 809–3766) vs. 802 (IQR: 355–2157 pg/mL); p < 0.001]. During a median follow-up of 21 months, 20 patients died and 40 had ≥ 1 HF hospitalization. In multivariate analysis, NYHA (III–IV vs. I–II; HR: 2.40; 95%-CI: 1.30–4.43; p = 0.005), LVEF (HR per 1%: 0.97; 95%-CI: 0.94–0.99; p = 0.031), serum creatinine (HR per 1 mg/dL: 2.51; 95%-CI: 1.36–4.61; p = 0.003) and LWD (HR per 1%: 1.07; 95%-CI: 1.02–1.12; p = 0.007) were independent predictors of the primary endpoint. These findings were mainly driven by an association between LWD and HF hospitalization (p = 0.026). A CMR-derived LWD quantification was independently associated with an increased HF hospitalization risk in HF patients with LVEF < 50%. LWD is a simple, reproducible and straightforward measurement, with prognostic value in HF.
Highlights
To assess whether a simplified cardiac magnetic resonance (CMR)–derived lung water density (LWD) quantification predicted major events in Heart Failure (HF)
regions of interest (ROI) tracing for LWD measurements lasted on average 35 ± 4 s
The simplified LWD quantification method was associated with good reproducibility: Lin’s concordance correlation coefficient of 0.95 [95% Confidence Interval (CI) 0.935–0.965; p < 0.001], with minimal bias according to the Bland–Altman analysis—Fig. S1
Summary
To assess whether a simplified cardiac magnetic resonance (CMR)–derived lung water density (LWD) quantification predicted major events in Heart Failure (HF). Its quantification by thermodilution has been shown to correlate with increased left atrial, pulmonary wedge and/or diastolic pressures in series of patients with acute myocardial infarction[5], chronic coronary syndrome[6] and HF7 Imaging tests, such as chest radiography[8] and lung ultrasonography[9] are currently used in clinical practice as semi-quantitative measurements to assess the burden of pulmonary congestion and to discriminate it from non-cardiac causes of increased lung fluid. It has been recently demonstrated that Lung Water Density (LWD) measured by this method independently predicts all-cause death, cardiovascular hospitalization or emergency department visit within 1-year in a cohort of patients with or at-risk of HF. We aimed to assess whether a simplified CMR-derived LWD determination was feasible and correlated with major events in patients with HF and LVEF < 50%
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