Myocardial deformation assessed among heart failure entities by cardiovascular magnetic resonance imaging

Hashemi, Djawid; Motzkus, Laura Astrid; Blum, Moritz; Kraft, Robin; Tanacli, Radu; Tahirović, Elvis; Doeblin, Patrick; Zieschang, Victoria; Zamani, Seyedeh Mahsa; Kelm, Marcus; Küehne, Titus; Pieske, Burkert; Alogna, Alessio; Edelmann, Frank; Düengen, Hans-Dirk; Kelle, Sebastian

doi:10.1002/ehf2.13193

Cited by 15 publications

(36 citation statements)

References 25 publications

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“…During stress the impaired septal segments improved primarily in terms of circumferential strain ( Figure 1B ). It has been shown that septal impairment precedes global systolic dysfunction, highlighting the relevance of septal assessments in the future ( 10 ).…”

Section: Resultsmentioning

confidence: 99%

“…This study was a prospective study conducted in Berlin, Germany, approved by the local Ethics Committee (registration: EA4/112/16; German Clinical Trials Registry, DRKS, DRKS00015615). Its rationale and design have been described previously ( 10 – 13 ).…”

Section: Methodsmentioning

confidence: 99%

“…CV co-morbidities or evidence of cardiac dysfunction were defined as the presence of diabetes, suboptimal managed arterial hypertension (hypertensive values at rest despite medication), increased NT-proBNP levels (>120 pg/dL), or LV hypertrophy (LV wall thickness > 11 mm) on CMR (minimum 1 criterion). They were compared to (c) patients with HFpEF ( 10 ). We performed CMR scans at rest and during a non-invasive, medication-free stress test.…”

Section: Methodsmentioning

confidence: 99%

“…All CMR images were acquired using 1.5 T, fast strain-encoded MRI was used for strain evaluation. Volume measurements were performed with Medis ® Suite MR (Medis medical imaging systems, Leiden, The Netherlands, version 3.1), strain analysis by MyoStrain (Myocardial Solutions, Inc., Morrisville, North Carolina, USA, version 5.2) ( 10 , 11 ).…”

Section: Methodsmentioning

confidence: 99%

“…Myocardial strain analysis may detect impaired myocardial contractility in patients despite a preserved LVEF ( 9 ). Regional strain assessment seems to be superior to global strain analysis in describing deformation impairment in HF ( 10 ). The MyoHealth score reflects the share of LV segments with preserved strain values (≤ −17%) in a 37 segment model ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

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CMR detects decreased myocardial deformation in asymptomatic patients at risk for heart failure

Hashemi

Doeblin

Blum

et al. 2023

Front. Cardiovasc. Med.

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AimsThe main management strategy of heart failure with preserved ejection fraction (HFpEF) is prevention since HFpEF is associated with many cardiovascular (CV) risk factors, especially since HFpEF is linked to a high risk for both mortality and recurrent heart failure (HF) hospitalizations. Therefore, there is a need for new tools to identify patients with a high risk profile early. Regional strain assessment by CMR seems to be superior in describing deformation impairment in HF. The MyoHealth score is a promising tool to identify cardiac changes early.Methods and resultsHeart failure patients irrespective of LVEF and asymptomatic controls were recruited, and CMR based measures were obtained. For this analysis the asymptomatic control group (n = 19) was divided into asymptomatic subjects without CV co-morbidities or evidence of cardiac abnormalities and (n = 12) and asymptomatic subjects with CV co-morbidities or evidence of cardiac abnormalities (n = 7) as well as patients with HFpEF (n = 19). We performed CMR scans at rest and during a stress test using isometric handgrip exercise (HG). Assessing the MyoHealth score at rest revealed preserved regional strain in 85 ± 9% of LV segments in controls, 73 ± 11% in at Risk subjects and 73 ± 8% in HFpEF patients. During stress the MyoHealth score was 84 ± 7% in controls, 83 ± 7 in at risk subjects and 74 ± 11 in HFpEF patients.ConclusionIn summary, we show for the first time that asymptomatic subjects with increased CV risk present with HFpEF like impaired myocardial deformation at rest, while they show results like controls under HG stress. The potential of preventive treatment in this group of patients merits further investigation in future.Clinical trial registration[https://drks.de/search/de/trial/DRKS00015615], identifier [DRKS00015615].

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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CMR detects decreased myocardial deformation in asymptomatic patients at risk for heart failure

Hashemi

Doeblin

Blum

et al. 2023

Front. Cardiovasc. Med.

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CMR-based cardiac phenotyping in different forms of heart failure

Lange,

Backhaus,

Schulz

et al. 2024

Int J Cardiovasc Imaging

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Heart failure (HF) is a heterogenous disease requiring precise diagnostics and knowledge of pathophysiological processes. Since structural and functional imaging data are scarce we hypothesized that cardiac magnetic resonance (CMR)-based analyses would provide accurate characterization and mechanistic insights into different HF groups comprising preserved (HFpEF), mid-range (HFmrEF) and reduced ejection fraction (HFrEF). 22 HFpEF, 17 HFmrEF and 15 HFrEF patients as well as 19 healthy volunteers were included. CMR image assessment contained left atrial (LA) and left ventricular (LV) volumetric evaluation as well as left atrioventricular coupling index (LACI). Furthermore, CMR feature-tracking included LV and LA strain in terms of reservoir (Es), conduit (Ee) and active boosterpump (Ea) function. CMR-based tissue characterization comprised T1 mapping as well as late-gadolinium enhancement (LGE) analyses. HFpEF patients showed predominant atrial impairment (Es 20.8%vs.25.4%, p = 0.02 and Ee 8.3%vs.13.5%, p = 0.001) and increased LACI compared to healthy controls (14.5%vs.23.3%, p = 0.004). Patients with HFmrEF showed LV enlargement but mostly preserved LA function with a compensatory increase in LA boosterpump (LA Ea: 15.0%, p = 0.049). In HFrEF LA and LV functional impairment was documented (Es: 14.2%, Ee: 5.4% p < 0.001 respectively; Ea: 8.8%, p = 0.02). This was paralleled by non-invasively assessed progressive fibrosis (T1 mapping and LGE; HFrEF > HFmrEF > HFpEF). CMR-imaging reveals insights into HF phenotypes with mainly atrial affection in HFpEF, ventricular affection with atrial compensation in HFmrEF and global impairment in HFrEF paralleled by progressive LV fibrosis. These data suggest a necessity for a personalized HF management based on imaging findings for future optimized patient management.

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Noninvasive evaluation of pulmonary artery stiffness in heart failure patients via cardiovascular magnetic resonance

Hou,

Hashemi,

Erley

et al. 2023

Sci Rep

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Heart failure (HF) presents manifestations in both cardiac and vascular abnormalities. Pulmonary hypertension (PH) is prevalent in up 50% of HF patients. While pulmonary arterial hypertension (PAH) is closely associated with pulmonary artery (PA) stiffness, the association of HF caused, post-capillary PH and PA stiffness is unknown. We aimed to assess and compare PA stiffness and blood flow hemodynamics noninvasively across HF entities and control subjects without HF using CMR. We analyzed data of a prospectively conducted study with 74 adults, including 55 patients with HF across the spectrum (20 HF with preserved ejection fraction [HFpEF], 18 HF with mildly-reduced ejection fraction [HFmrEF] and 17 HF with reduced ejection fraction [HFrEF]) as well as 19 control subjects without HF. PA stiffness was defined as reduced vascular compliance, indicated primarily by the relative area change (RAC), altered flow hemodynamics were detected by increased flow velocities, mainly by pulse wave velocity (PWV). Correlations between the variables were explored using correlation and linear regression analysis. PA stiffness was significantly increased in HF patients compared to controls (RAC 30.92 ± 8.47 vs. 50.08 ± 9.08%, p < 0.001). PA blood flow parameters were significantly altered in HF patients (PWV 3.03 ± 0.53 vs. 2.11 ± 0.48, p < 0.001). These results were consistent in all three HF groups (HFrEF, HFmrEF and HFpEF) compared to the control group. Furthermore, PA stiffness was associated with higher NT-proBNP levels and a reduced functional status. PA stiffness can be assessed non-invasively by CMR. PA stiffness is increased in HFrEF, HFmrEF and HFpEF patients when compared to control subjects.Trial registration The study was registered at the German Clinical Trials Register (DRKS, registration number: DRKS00015615).

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Myocardial deformation assessed among heart failure entities by cardiovascular magnetic resonance imaging

Cited by 15 publications

References 25 publications

CMR detects decreased myocardial deformation in asymptomatic patients at risk for heart failure

CMR detects decreased myocardial deformation in asymptomatic patients at risk for heart failure

CMR-based cardiac phenotyping in different forms of heart failure

Noninvasive evaluation of pulmonary artery stiffness in heart failure patients via cardiovascular magnetic resonance

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