Universität zu Köln

Backhaus, Soeren J., Lange, Torben, George, Elisabeth F., Hellenkamp, Kristian, Gertz, Roman J., Billing, Marcus, Wachter, Rolf ORCID: 0000-0003-2231-2200, Steinmetz, Michael, Kutty, Shelby, Raaz, Uwe, Lotz, Joachim, Friede, Tim ORCID: 0000-0001-5347-7441, Uecker, Martin, Hasenfuss, Gerd, Seidler, Tim ORCID: 0000-0002-6158-5087 and Schuster, Andreas (2021). Exercise Stress Real-Time Cardiac Magnetic Resonance Imaging for Noninvasive Characterization of Heart Failure With Preserved Ejection Fraction The HFpEF-Stress Trial. Circulation, 143 (15). S. 1484 - 1499. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1524-4539

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Abstract

BACKGROUND: Right heart catheterization using exercise stress is the reference standard for the diagnosis of heart failure with preserved ejection fraction (HFpEF) but carries the risk of the invasive procedure. We hypothesized that real-time cardiac magnetic resonance (RT-CMR) exercise imaging with pathophysiologic data at excellent temporal and spatial resolution may represent a contemporary noninvasive alternative for diagnosing HFpEF. METHODS: The HFpEF-Stress trial (CMR Exercise Stress Testing in HFpEF; URL: ; Unique identifier: NCT03260621. URL: ; Unique identifier: DZHK-17) prospectively recruited 75 patients with echocardiographic signs of diastolic dysfunction and dyspnea on exertion (E/e '>8, New York Heart Association class >= II) to undergo echocardiography, right heart catheterization, and RT-CMR at rest and during exercise stress. HFpEF was defined according to pulmonary capillary wedge pressure (>= 15 mm Hg at rest or >= 25 mm Hg during exercise stress). RT-CMR functional assessments included time-volume curves for total and early (1/3) diastolic left ventricular filling, left atrial (LA) emptying, and left ventricular/LA long axis strain. RESULTS: Patients with HFpEF (n=34; median pulmonary capillary wedge pressure at rest, 13 mm Hg; at stress, 27 mm Hg) had higher E/e ' (12.5 versus 9.15), NT-proBNP (N-terminal pro-B-type natriuretic peptide; 255 versus 75 ng/L), and LA volume index (43.8 versus 36.2 mL/m(2)) compared with patients with noncardiac dyspnea (n=34; rest, 8 mm Hg; stress, 18 mm Hg; P <= 0.001 for all). Seven patients were excluded because of the presence of non-HFpEF cardiac disease causing dyspnea on imaging. There were no differences in RT-CMR left ventricular total and early diastolic filling at rest and during exercise stress (P >= 0.164) between patients with HFpEF and noncardiac dyspnea. RT-CMR revealed significantly impaired LA total and early (P<0.001) diastolic emptying in patients with HFpEF during exercise stress. RT-CMR exercise stress LA long axis strain was independently associated with HFpEF (adjusted odds ratio, 0.657 [95% CI, 0.516-0.838]; P=0.001) after adjustment for clinical and imaging measures and emerged as the best predictor for HFpEF (area under the curve at rest 0.82 versus exercise stress 0.93; P=0.029). CONCLUSIONS: RT-CMR allows highly accurate identification of HFpEF during physiologic exercise and qualifies as a suitable noninvasive diagnostic alternative. These results will need to be confirmed in multicenter prospective research studies to establish widespread routine clinical use. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03260621. URL: https://dzhk.de/; Unique identifier: DZHK-17.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Backhaus, Soeren J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lange, Torben UNSPECIFIED UNSPECIFIED UNSPECIFIED George, Elisabeth F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hellenkamp, Kristian UNSPECIFIED UNSPECIFIED UNSPECIFIED Gertz, Roman J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Billing, Marcus UNSPECIFIED UNSPECIFIED UNSPECIFIED Wachter, Rolf UNSPECIFIED orcid.org/0000-0003-2231-2200 UNSPECIFIED Steinmetz, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Kutty, Shelby UNSPECIFIED UNSPECIFIED UNSPECIFIED Raaz, Uwe UNSPECIFIED UNSPECIFIED UNSPECIFIED Lotz, Joachim UNSPECIFIED UNSPECIFIED UNSPECIFIED Friede, Tim UNSPECIFIED orcid.org/0000-0001-5347-7441 UNSPECIFIED Uecker, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Hasenfuss, Gerd UNSPECIFIED UNSPECIFIED UNSPECIFIED Seidler, Tim UNSPECIFIED orcid.org/0000-0002-6158-5087 UNSPECIFIED Schuster, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-594666
DOI:	10.1161/CIRCULATIONAHA.120.051542
Journal or Publication Title:	Circulation
Volume:	143
Number:	15
Page Range:	S. 1484 - 1499
Date:	2021
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1524-4539
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Cardiac & Cardiovascular Systems; Peripheral Vascular Disease Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59466