Background
Methods
Validation cohort
Prospective cohort
MRI protocol
Lung water analysis
Statistics and outcomes
Results
Validation Cohort | Prospective Cohort | ||||||
---|---|---|---|---|---|---|---|
Normal | At-Risk | HFrEF | HFpEF | ||||
NYHA I/II
|
NYHA III/IV
|
NYHA I/II
|
NYHA III/IV
| ||||
Patients, n | 53 | 82 | 36 | 15 | 52 | 18 | |
Male sex, n (%)* | 19 (84) | 16 (30) | 44 (54)† | 26 (72)† | 6 (40) | 30 (58)† | 4 (22) |
Age at CMR, years* | 51 ± 13 | 65 ± 11 | 64 ± 10 | 66 ± 10 | 67 ± 16 | 68 ± 12 | 76 ± 9† |
Height, cm* | 173 ± 11 | 168 ± 9 | 170 ± 10 | 172 ± 10† | 166 ± 9 | 170 ± 9 | 161 ± 11† |
Weight, kg* | 89 ± 21 | 70 ± 12 | 81 ± 16† | 89 ± 19† | 85 ± 18† | 88 ± 15† | 78 ± 19 |
BMI, kg/m2* | 29 ± 7 | 25 ± 3 | 28 ± 5† | 30 ± 5† | 31 ± 7† | 31 ± 5† | 30 ± 8† |
HR, min− 1 | 71 ± 22 | 70 ± 11 | 68 ± 13 | 72 ± 17 | 73 ± 12 | 69 ± 11 | 67 ± 12 |
Systolic BP, mmHg* | 137 ± 23 | 131 ± 21 | 139 ± 19† | 128 ± 21 | 121 ± 18 | 129 ± 18 | 132 ± 17 |
Diastolic BP, mmHg* | 77 ± 15 | 76 ± 10 | 82 ± 13† | 77 ± 18 | 71 ± 13 | 73 ± 14 | 74 ± 11 |
Comorbidities, n(%) | |||||||
Diabetes* | NA | 0 (0) | 19 (23)† | 14 (39)† | 7 (47)† | 18 (35)† | 8 (44)† |
Hypertension* | NA | 0 (0) | 74 (90)† | 21 (58)† | 8 (53)† | 38 (73)† | 15 (83)† |
CAD/MI* | NA | 0 (0) | 23 (28)† | 22 (61)† | 6 (40)† | 16 (31)† | 7 (39)† |
Current smoker* | NA | 2 (4) | 11 (13) | 2 (6) | 2 (13) | 8 (15)* | 0 (0) |
COPD* | NA | 0 (0) | 7 (9)† | 5 (14)† | 5 (33)† | 8 (15)† | 7 (39)† |
AFib* | NA | 0 (0) | 16 (20)† | 13 (36)† | 7 (47)† | 24 (46)† | 8 (44)† |
Medications at baseline, n(%) | |||||||
Beta blocker* | NA | 0 (0) | 32 (39)† | 32 (89)† | 13 (87)† | 43 (83)† | 16 (89)† |
ACEi or ARB* | NA | 0 (0) | 64 (78)† | 33 (92)† | 14 (93)† | 41 (79)† | 16 (89)† |
Laboratory results | |||||||
BNP, pg/ml* | 505 ± 465 | 31 ± 20 | 53 ± 68† | 244 ± 256† | 381 ± 391† | 144 ± 148† | 265 ± 205† |
Creatinine, umol/L | NA | 97 ± 140 | 82 ± 19 | 93 ± 25 | 98 ± 60 | 105 ± 43 | 100 ± 36 |
MRI measurements | |||||||
LVEF, %* | 37 ± 18 | 63 ± 6 | 61 ± 9 | 32 ± 9† | 34 ± 9† | 56 ± 8† | 59 ± 8† |
LVEDVi, ml/m2* | 122 ± 56 | 70 ± 11 | 73 ± 19 | 119 ± 42† | 115 ± 38† | 75 ± 24 | 75 ± 22 |
LV Massi, g/m2* | 99 ± 35 | 52 ± 10 | 61 ± 14† | 86 ± 23† | 82 ± 23† | 68 ± 13† | 65 ± 14† |
LV Mass / LVEDV* | 0.87 ± 0.25 | 0.76 ± 0.15 | 0.85 ± 0.16† | 0.75 ± 0.17 | 0.74 ± 0.19 | 0.95 ± 0.23† | 0.90 ± 0.22† |
Validation cohort
Prospective cohort
CMR derived Lung Water Density Normal (≤ 20.8%) Wet (> 20.8%) | P value | ||
---|---|---|---|
Patients, n | 151 | 52 | |
Male sex, n(%) | 86 (57) | 24 (46) | 0.18 |
Age at CMR, years | 67 ± 11 | 65 ± 12 | 0.18 |
BMI, kg/m2 | 29 ± 5 | 31 ± 7 | 0.002 |
Current smoker, n(%) | 21 (14) | 2 (4) | 0.048 |
Diabetes, n(%) | 48 (32) | 18 (35) | 0.71 |
Hypertension, n(%) | 118 (78) | 38 (73) | 0.46 |
CAD/MI, n(%) | 57 (38) | 17 (33) | 0.51 |
Atrial Fibrillation, n(%) | 51 (34) | 17 (33) | 0.89 |
COPD, n(%) | 20 (13) | 12 (23) | 0.09 |
Beta Blocker use, n(%) | 97 (64) | 39 (75) | 0.15 |
ACEi or ARB use, n(%) | 123 (81) | 45 (87) | 0.40 |
Loop diuretic use, n(%) | 61 (40) | 31 (60) | 0.016 |
Spironolactone use, n(%) | 27 (18) | 10 (19) | 0.83 |
History of heart failure | 83 (55) | 38 (73) | 0.022 |
NYHA, n(%) | 0.002 | ||
Class I | 25 (30) | 3 (8) | |
Class II | 43 (52) | 17 (45) | |
Class III | 15 (18) | 17 (45) | |
Class IV | 0 (0) | 1 (3) | |
Systolic BP, mmHg | 133 ± 19 | 132 ± 22 | 0.75 |
Elevated JVP, n(%) | 25 (17) | 19 (37) | 0.003 |
Rales, n(%) | 5 (3) | 7 (13) | 0.007 |
BNP, pg/ml | 111 ± 122 | 282 ± 330 | < 0.001 |
Creatinine, umol/L | 91 ± 32 | 96 ± 39 | 0.38 |
LVEF, %, by MRI | 54 ± 13 | 48 ± 19 | 0.013 |
Outcomes at 1 year, n(%) | |||
Death | 1 (1) | 3 (6) | 0.022 |
Death, CV hosp or CV ED visit | 19 (13) | 15 (29) | 0.007 |
Univariate Predictors | Patients with or at risk for HF (N = 203, 34 events) | Only Patients with HF (N = 121, 28 events) | ||||
---|---|---|---|---|---|---|
HR | 95% CI | p-value | HR | 95% CI | p-value | |
Age at CMR, 10 year | 1.9 | (1.3, 2.8) | < 0.001 | 1.8 | (1.2,2.6) | 0.004 |
Female gender | 1.4 | (0.7, 2.8) | 0.31 | 1.8 | (0.8, 3.8) | 0.13 |
BMI, 1 kg/m2 | 1.0 | (0.9, 1.1) | 0.75 | 0.9 | (0.9. 1.0) | 0.06 |
Current smoker | 1.0 | (0.4, 2.9) | 0.96 | 0.6 | (0.2. 2.7) | 0.54 |
Diabetes | 1.3 | (0.7, 2.6) | 0.42 | 1.2 | (0.6. 2.6) | 0.62 |
Hypertension | 0.7 | (0.3, 1.5) | 0.4 | 0.9 | (0.4. 1.9) | 0.77 |
CAD/MI | 1.2 | (0.6, 2.4) | 0.58 | 0.9 | (0.4. 1.8) | 0.69 |
Atrial Fibrillation | 1.3 | (0.6, 2.6) | 0.48 | 0.9 | (0.4. 1.9) | 0.73 |
COPD | 1.7 | (0.8, 3.8) | 0.18 | 1.3 | (0.5, 3.0) | 0.58 |
History of heart failure | 3.5 | (1.4, 8.4) | 0.006 | na | na | na |
NYHA class III or IV | 4.1 | (2.0, 8.2) | < 0.001 | 2.9 | (1.4, 6.2) | 0.005 |
Beta blocker at baseline | 3.1 | (1.2, 8.0) | 0.02 | 1.4 | (0.4, 4.5) | 0.62 |
ACEi or ARB at baseline | 1.2 | (0.5, 3.1) | 0.71 | 0.9 | (0.3, 2.8) | 0.94 |
Loop diuretic at baseline | 2.4 | (1.2, 4.8) | 0.02 | 1.4 | (0.6, 3.3) | 0.42 |
Systolic BP, 10 mmHg | 1.0 | (0.8, 1.1) | 0.56 | 1.1 | (0.9. 1.3) | 0.56 |
BNP, 100 pg/ml | 1.2 | (1.1, 1.3) | < 0.001 | 1.2 | (1.1, 1.3) | < 0.001 |
Creatinine, 10 umol/L | 1 | (1.0, 1.2) | 0.033 | 1.0 | (0.9, 1.1) | 0.53 |
LVEF, 10% | 0.9 | (0.7, 1.1) | 0.35 | 1.1 | (0.9, 1.5) | 0.43 |
Lung water density > 20.8% | 2.6 | (1.3, 5.6) | 0.005 | 2.6 | (1.3, 5.6) | 0.01 |
Multivariable Predictors | Patients with or at risk for HF (N = 203, 34 events) | Only Patients with HF (N = 121, 28 events) | ||||
---|---|---|---|---|---|---|
HR | 95% CI | p-value | HR | 95% CI | p-value | |
Age at CMR, 10 year | 2.2 | (1.5, 3.1) | < 0.001 | 2.2 | (1.4, 3.3) | < 0.001 |
BNP, 100 pg/ml | 1.2 | (1.1, 1.4) | < 0.001 | 1.2 | (1.0, 1.3) | 0.011 |
Lung water density > 20.8% | 2.4 | (1.1, 5.1) | 0.03 | 2.8 | (1.2, 6.4) | 0.017 |