Global myocardial oedema in advanced decompensated heart failure

Aims To use cardiac magnetic resonance (CMR) imaging with quantitative T2 mapping as surrogate for myocardial water content in patients with advanced decompensated heart failure (ADHF), compare these values with T2-values observed in chronic heart failure, and evaluate the change with decongestive therapy. Methods and results Volumetric CMR measurements and quantitative T2 mapping were performed in 18 consecutive ADHF patients with clinical signs of volume overload. Eleven patients with stable heart failure were used as controls. Vasodilator therapy and diuretics were administered to achieve a pulmonary arterial wedge pressure (PAWP) of <18 mmHg and central venous pressure (CVP) of <12 mmHg, after which CMR was repeated. ADHF patients (62 +/- 12 years; 89% male; left ventricular ejection fraction 23 +/- 8%) presented with low cardiac index (2.08 +/- 0.59 L/min/m(2)), high PAWP (25 +/- 7 mmHg), and high CVP (14 +/- 5 mmHg). After decongestion, the patients had a significant increase in cardiac index (+0.41 +/- 0.53 L/min/m(2); P = 0.005) and decreases in both PAWP (-9 +/- 6 mmHg; P < 0.001) and CVP (-6 +/- 5 mmHg; P < 0.001). At baseline, global left ventricular T2-values were higher in ADHF patients compared with controls (59.5 +/- 4.6 vs. 54.7 +/- 2.2 ms, respectively; P = 0.001). After decongestion, T2-values fell significantly to 55.9 +/- 5.1 ms (P = 0.001), comparable with controls (P = 0.580). In contrast, psoas muscle T2-values were similar at baseline (38.6 +/- 4.4 ms) vs. after decongestion (37.8 +/- 4.8 ms; P = 0.397). Each 1 ms decrease in global left ventricular T2-value during decongestion was associated with a 1.14 +/- 0.40 mmHg decrease in PAWP (P = 0.013), after correction for age and gender. Conclusion Patients presenting with ADHF and volume overload have increased global left ventricular-but not psoas muscle-T2-values, which decrease with successful decongestion. Relief of myocardial oedema correlates with haemodynamic unloading.