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Cardiovascular magnetic resonance phenotyping of heart failure with mildly reduced ejection fraction

Brown, Louise AE; Wahab, Ali; Ikongo, Eunice; Saunderson, Chirstopher ED; Jex, Nicholas; Thirunavukarasu, Sharmaine; Chowdhary, Amrit; ... Swoboda, Peter P; + view all (2022) Cardiovascular magnetic resonance phenotyping of heart failure with mildly reduced ejection fraction. European Heart Journal - Cardiovascular Imaging , 24 (1) pp. 38-45. 10.1093/ehjci/jeac204. Green open access

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Abstract

AIMS: The 2016 European Society of Cardiology Heart Failure Guidelines defined a new category: heart failure with mid-range ejection fraction (HFmrEF) of 40-49%. This new category was highlighted as having limited evidence and research was advocated into underlying characteristics, pathophysiology, and diagnosis. We used multi-parametric cardiovascular magnetic resonance (CMR) to define the cardiac phenotype of presumed non-ischaemic HFmrEF. METHODS AND RESULTS: Patients (N = 300, 62.7 ± 13 years, 63% males) with a clinical diagnosis of heart failure with no angina symptoms, history of myocardial infarction, or coronary intervention were prospectively recruited. Patients underwent clinical assessment and CMR including T1 mapping, extracellular volume (ECV) mapping, late gadolinium enhancement, and measurement of myocardial blood flow at rest and maximal hyperaemia. Of 273 patients in the final analysis, 93 (34%) patients were categorized as HFmrEF, 46 (17%) as heart failure with preserved ejection fraction (HFpEF), and 134 (49%) as heart failure with reduced ejection fraction (HFrEF). Nineteen (20%) patients with HFmrEF had evidence of occult ischaemic heart disease. Diffuse fibrosis and hyperaemic myocardial blood flow were similar in HFmrEF and HFpEF, but HFmrEF showed significantly lower native T1 (1311 ± 32 vs. 1340 ± 45 ms, P < 0.001), ECV (24.6 ± 3.2 vs. 26.3 ± 3.1%, P < 0.001), and higher myocardial perfusion reserve (2.75 ± 0.84 vs. 2.28 ± 0.84, P < 0.001) compared with HFrEF. CONCLUSION: Patients with HFmrEF share most phenotypic characteristics with HFpEF, including the degree of microvascular impairment and fibrosis, but have a high prevalence of occult ischaemic heart disease similar to HFrEF. Further work is needed to confirm how the phenotype of HFmrEF responds to medical therapy.

Type: Article
Title: Cardiovascular magnetic resonance phenotyping of heart failure with mildly reduced ejection fraction
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/ehjci/jeac204
Publisher version: https://doi.org/10.1093/ehjci/jeac204
Language: English
Additional information: © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Keywords: Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Radiology, Nuclear Medicine & Medical Imaging, Cardiovascular System & Cardiology, heart failure, mildly reduced, ejection fraction, cardiovascular magnetic resonance, HFmrEF, BLOOD-FLOW, PROGNOSTIC RELEVANCE, MYOCARDIAL-ISCHEMIA, ESC GUIDELINES, MIDRANGE, ASSOCIATION, IMPAIRMENT, CARDIOLOGY, DIAGNOSIS, DISEASE
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10163234
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