The right heart in heart failure with preserved ejection fraction: insights from cardiac magnetic resonance imaging and invasive haemodynamics

2015 ◽  
Vol 18 (1) ◽  
pp. 71-80 ◽  
Author(s):  
Stefan Aschauer ◽  
Andreas A. Kammerlander ◽  
Caroline Zotter-Tufaro ◽  
Robin Ristl ◽  
Stefan Pfaffenberger ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Cardiac Magnetic Resonance Imaging ◽  
Preserved Ejection Fraction ◽  
Resonance Imaging ◽  
Right Heart ◽  
The Right

scholarly journals EXPRESS: Cardiac biomarkers as indicators of right ventricular dysfunction and recovery in CTEPH patients after BPA therapy – a cardiac magnetic resonance imaging cohort study

2021 ◽  
pp. 204589402110565
Author(s):  
Steffen Kriechbaum ◽  
Julia M Vietheer ◽  
CB Wiedenroth ◽  
Felix Rudolph ◽  
Marta A. Barde ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Heart Failure ◽  
Cohort Study ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Magnetic Resonance Imaging ◽  
Right Heart Failure ◽  
Cardiac Biomarkers ◽  
Resonance Imaging ◽  
Right Heart

BACKGROUND: In chronic thromboembolic pulmonary hypertension (CTEPH), right heart failure determines outcome. Balloon pulmonary angioplasty (BPA) therapy allows right heart recovery, which can be monitored by cardiac magnetic resonance imaging (CMR). This study evaluates whether cardiac biomarkers (NT-proBNP, MR-proANP, sST2, PAPP-A) are associated with CMR findings prior to and after BPA therapy. METHODS: This observational cohort study enrolled 22 CTEPH patients who underwent BPA therapy and completed a 6-month follow-up including CMR. Biomarker levels were compared with findings for right heart morphology and function derived from CMR. RESULTS: Pulmonary hemodynamics improved after BPA therapy [PVR: 7.7 (6.0-9.0) vs. 4.7 (3.5-5.5) WU, p<0.001; meanPAP 41 (38-47) vs. 32 (28-37) mmHg, p<0.001]. CMR findings indicated right heart maladaptation at baseline and recovery after therapy [RVEDV 192 (141-229) ml vs. 143 (128-172) ml, p=0.002; RVESV 131 (73-157) ml vs. 77 (61-99) ml (p<0.001); RVEF 34 (28-41) % vs. 52 (41-54) %; p<0.001]. Biomarker level cut-offs [NT-proBNP 347 ng/L (AUC 0.91), MR-proANP 230 pg/L (AUC 0.78), PAPP-A 14.5 mU/L (AUC 0.81), sST2 48.0 ng/ml (AUC 0.88)] indicated a RVEF ≤35% at baseline. The dynamics of NT-proBNP (rs =-0.79; p<0.001), MR-proANP (rs =-0.80; p<0.001), and sST2 (rs =-0.49; p=0.02) correlated inversely with the improvement in RVEF after therapy. A relative decrease of NT-proBNP <53% (AUC 0.86) and MR-proANP <24% (AUC 0.82) indicated a limited RVEF response. CONCLUSIONS: In CTEPH patients, CMR findings illustrate right heart failure and recovery after BPA therapy. Cardiac biomarker levels correlate with right heart parameters at baseline and their dynamics after therapy.

Abstract 11776: Relative Merits of Ejection Fraction and Strain by 2D Echo, 3D Echo and Cardiac Magnetic Resonance Imaging for Image-Based Recognition of Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Samir K Saha ◽  
Rena S Toole ◽  
Anatoli Kiotsekoglou ◽  
Jie J Cao ◽  
Nathaniel Reichek ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Cardiac Magnetic Resonance Imaging ◽  
Systolic Dysfunction ◽  
Resonance Imaging ◽  
Backward Elimination ◽  
Sensitivity Specificity

Introduction: Echo and cardiac magnetic resonance imaging (CMR) are often used in evaluation of patients with heart failure (HF) whether associated with systolic dysfunction or preserved ejection fraction (EF). We evaluated the relative merits of EF (by CMR and 2D echo) versus echo strain (by 2D and 3D speckle tracking echo STE) for imaged-based recognition of patients with HF. Methods: 117 subjects (81 normals and 36 HF) were evaluated. There were no significant differences in age or gender between normals (59+/-14 yrs, 39 M) and HF (54+/-14 yrs, 29 M). 2D biplane echo and CMR provided EF while 2D and 3DSTE yielded global longitudinal (GLS %) and circumferential (GCS%) strains. Since 3DSTE was optimized for strain rather than EF, 3DEF was not evaluated. HF diagnosis was based on dyspnea, plasma N-terminal pro-B type brain natriuretic peptide and EF. Results: As expected, mean EF and strains differed between normals and HF (table). Using a backward elimination regression model, only 2DEF, CMREF, 2DGCS% and 3DGLS% were retained for further analysis. ROC-guided criterion values (for HF recognition) for 2DEF, CMREF, 2DGCS% and 3DGLS% were >52%, >50%, >-22% and >-16%, respectively. Using these values, the sensitivity, specificity, and odd-ratios for HF recognition with each parameter were computed (table). Conclusions: CMREF provided the highest sensitivity and specificity for HF recognition. The most sensitive echo measure was 3DGLS% while the most specific echo measure was 2DEF. However, in a mixed population of normals and HF, whether associated with systolic dysfunction or preserved EF, 2DGCS% and 3DGLS% had the highest odds ratios.

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