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01.12.2019 | Research | Ausgabe 1/2019 Open Access

Journal of Cardiovascular Magnetic Resonance 1/2019

Quantification of lung water in heart failure using cardiovascular magnetic resonance imaging

Zeitschrift:
Journal of Cardiovascular Magnetic Resonance > Ausgabe 1/2019
Autoren:
Richard B. Thompson, Kelvin Chow, Joseph J. Pagano, Viktor Sekowski, Evangelos D. Michelakis, Wayne Tymchak, Mark J. Haykowsky, Justin A. Ezekowitz, Gavin Y. Oudit, Jason R. B. Dyck, Padma Kaul, Anamaria Savu, D. Ian Paterson
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12968-019-0567-y) contains supplementary material, which is available to authorized users.

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Abstract

Background

Pulmonary edema is a cardinal feature of heart failure but no quantitative tests are available in clinical practice. The goals of this study were to develop a simple cardiovascular magnetic resonance (CMR) approach for lung water quantification, to correlate CMR derived lung water with intra-cardiac pressures and to determine its prognostic significance.

Methods

Lung water density (LWD, %) was measured using a widely available single-shot fast spin-echo acquisition in two study cohorts. Validation Cohort: LWD was compared to left ventricular end-diastolic pressure or pulmonary capillary wedge pressure in 19 patients with heart failure undergoing cardiac catheterization. Prospective Cohort: LWD was measured in 256 subjects, including 121 with heart failure, 82 at-risk for heart failure and 53 healthy controls. Clinical outcomes were evaluated up to 1 year.

Results

Within the validation cohort, CMR LWD correlated to invasively measured left-sided filling pressures (R = 0.8, p < 0.05). In the prospective cohort, mean LWD was 16.6 ± 2.1% in controls, 17.9 ± 3.0% in patients at-risk and 19.3 ± 5.4% in patients with heart failure, p < 0.001. In patients with or at-risk for heart failure, LWD >  20.8% (mean + 2 standard deviations of healthy controls) was an independent predictor of death, hospitalization or emergency department visit within 1 year, hazard ratio 2.4 (1.1–5.1, p = 0.03).

Conclusions

In patients with heart failure, increased CMR-derived lung water is associated with increased intra-cardiac filling pressures, and predicts 1 year outcomes. LWD could be incorporated in standard CMR scans.
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