Journal
JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE
Volume 21, Issue 1, Pages -Publisher
BMC
DOI: 10.1186/s12968-019-0567-y
Keywords
MRI; Lung water; Heart failure
Funding
- University Hospital Foundation
- Alberta Innovates-Health Solutions (AI-HS) [AHFMR ITG 200801018]
- AI-HS
- Heart and Stroke Foundation of Canada
- Moritz Chair in geriatrics in the College of Nursing and Health Innovation at The University of Texas at Arlington
- Canadian Institutes of Health Research
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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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