Hemodynamic force assessment by cardiovascular magnetic resonance in HFpEF: A case-control substudy from the HFpEF stress trial

Sören J. Backhaus; Harun Uzun; Simon F. Rösel; Alexander Schulz; Torben Lange; Richard J. Crawley; Ruben Evertz; Gerd Hasenfuß; Andreas Schuster

doi:10.1016/j.ebiom.2022.104334

Hemodynamic force assessment by cardiovascular magnetic resonance in HFpEF: A case-control substudy from the HFpEF stress trial

Sören J. Backhaus, Harun Uzun, Simon F. Rösel, Alexander Schulz, Torben Lange, Richard J. Crawley, Ruben Evertz, Gerd Hasenfuß, Andreas Schuster^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

10 Citations (Scopus)

Abstract

Background: The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. Exercise-stress testing is recommended in case of uncertainty; however, this approach is time-consuming and costly. Since preserved EF does not represent normal systolic function, we hypothesized comprehensive cardiovascular magnetic resonance (CMR) assessment of cardiac hemodynamic forces (HDF) may identify functional abnormalities in HFpEF. Methods: The HFpEF Stress Trial (DZHK-17; Clinicaltrials.gov: NCT03260621) prospectively recruited 75 patients with exertional dyspnea, preserved EF (≥50%) and signs of diastolic dysfunction (E/e’ ≥8) on echocardiography. Patients underwent rest and exercise-stress right heart catheterisation, echocardiography and CMR. The final study cohort consisted of 68 patients (HFpEF n = 34 and non-cardiac dyspnea n = 34 according to pulmonary capillary wedge pressure (PCWP)). HDF assessment included left ventricular (LV) longitudinal, systolic peak and impulse, systolic/diastolic transition, E-wave deceleration as well as A-wave acceleration forces. Follow-up after 24 months evaluated cardiovascular mortality and hospitalisation (CVH) – only two patients were lost to follow-up. Findings: HDF assessment revealed impairment of LV longitudinal function in patients with HFpEF compared to non-cardiac dyspnoea (15.8% vs. 18.3%, p = 0.035), attributable to impairment of systolic peak (38.6% vs 51.6%, p = 0.003) and impulse (20.8% vs. 24.5%, p = 0.009) forces as well as late diastolic filling (−3.8% vs −5.4%, p = 0.029). Early diastolic filling was impaired in HFpEF patients identified at rest compared with patients identified during stress only (7.7% vs. 9.9%, p = 0.004). Impaired systolic peak was associated with CVH (HR 0.95, p = 0.016), and was superior to LV global longitudinal strain assessment in prediction of CVH (AUC 0.76 vs. 0.61, p = 0.048). Interpretation: Assessment of HDF indicates impairment of LV systolic ejection force in HFpEF which is associated with cardiovascular events. Funding: German Centre for Cardiovascular Research (DZHK).

Original language	English
Article number	104334
Journal	EBioMedicine
Volume	86
DOIs	https://doi.org/10.1016/j.ebiom.2022.104334
Publication status	Published - Dec 2022

Keywords

Cardiovascular magnetic resonance
Deformation imaging
Hemodynamic force
HFpEF
Strain

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10.1016/j.ebiom.2022.104334

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@article{d3466ed9a58640178b7ea91e1a404f16,

title = "Hemodynamic force assessment by cardiovascular magnetic resonance in HFpEF: A case-control substudy from the HFpEF stress trial",

abstract = "Background: The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. Exercise-stress testing is recommended in case of uncertainty; however, this approach is time-consuming and costly. Since preserved EF does not represent normal systolic function, we hypothesized comprehensive cardiovascular magnetic resonance (CMR) assessment of cardiac hemodynamic forces (HDF) may identify functional abnormalities in HFpEF. Methods: The HFpEF Stress Trial (DZHK-17; Clinicaltrials.gov: NCT03260621) prospectively recruited 75 patients with exertional dyspnea, preserved EF (≥50%) and signs of diastolic dysfunction (E/e{\textquoteright} ≥8) on echocardiography. Patients underwent rest and exercise-stress right heart catheterisation, echocardiography and CMR. The final study cohort consisted of 68 patients (HFpEF n = 34 and non-cardiac dyspnea n = 34 according to pulmonary capillary wedge pressure (PCWP)). HDF assessment included left ventricular (LV) longitudinal, systolic peak and impulse, systolic/diastolic transition, E-wave deceleration as well as A-wave acceleration forces. Follow-up after 24 months evaluated cardiovascular mortality and hospitalisation (CVH) – only two patients were lost to follow-up. Findings: HDF assessment revealed impairment of LV longitudinal function in patients with HFpEF compared to non-cardiac dyspnoea (15.8% vs. 18.3%, p = 0.035), attributable to impairment of systolic peak (38.6% vs 51.6%, p = 0.003) and impulse (20.8% vs. 24.5%, p = 0.009) forces as well as late diastolic filling (−3.8% vs −5.4%, p = 0.029). Early diastolic filling was impaired in HFpEF patients identified at rest compared with patients identified during stress only (7.7% vs. 9.9%, p = 0.004). Impaired systolic peak was associated with CVH (HR 0.95, p = 0.016), and was superior to LV global longitudinal strain assessment in prediction of CVH (AUC 0.76 vs. 0.61, p = 0.048). Interpretation: Assessment of HDF indicates impairment of LV systolic ejection force in HFpEF which is associated with cardiovascular events. Funding: German Centre for Cardiovascular Research (DZHK).",

keywords = "Cardiovascular magnetic resonance, Deformation imaging, Hemodynamic force, HFpEF, Strain",

author = "Backhaus, {S{\"o}ren J.} and Harun Uzun and R{\"o}sel, {Simon F.} and Alexander Schulz and Torben Lange and Crawley, {Richard J.} and Ruben Evertz and Gerd Hasenfu{\ss} and Andreas Schuster",

note = "Funding Information: The study received funding from and was carried out using clinical-scientific infrastructure of the DZHK ( German Centre for Cardiovascular Research ). The DZHK had no role in study design, data collection, analyses or interpretation as well as writing of reports. Funding Information: German Centre for Cardiovascular Research (DZHK).Exercise-stress was conducted using supine bicycle ergometry. At an average rotation speed of 50–60 rotations per minute, a 5 Watt increasing ramp protocol was used to stress patients, until an average heart rate of 100 beats/min was achieved before starting data acquisition. If necessary, the workload was adjusted to maintain heart rates between 100 and 110 beats/min. Hemodynamic changes (blood pressure and heart rate) at rest and during exercise-stress are given in Table S1. Data acquisition was performed in stable sinus rhythm only. HFpEF was defined based on elevated pulmonary capillary wedge pressures (PCWP) of ≥15 mmHg at rest or ≥25 mmHg during exercise-stress RHC assessments according to current guideline recommendations.8 Otherwise patients were classified as non-cardiac dyspnoea in the absence of evidence pointing towards cardiovascular disease. A telephone follow-up consultation was conducted 24 months after initial recruitment (Fig. 1).21 Primary clinical endpoints were cardiovascular mortality and admission for congestive heart failure (cardiovascular hospitalisation (CVH)). The study was funded by the German Centre for Cardiovascular Research (DZHK-17).The study received funding from and was carried out using clinical-scientific infrastructure of the DZHK (German Centre for Cardiovascular Research). The DZHK had no role in study design, data collection, analyses or interpretation as well as writing of reports.Funding: German Centre for Cardiovascular Research (DZHK). Publisher Copyright: {\textcopyright} 2022 The Author(s)",

year = "2022",

month = dec,

doi = "10.1016/j.ebiom.2022.104334",

language = "English",

volume = "86",

journal = "EBioMedicine",

issn = "2352-3964",

publisher = "Elsevier BV",

}

TY - JOUR

T1 - Hemodynamic force assessment by cardiovascular magnetic resonance in HFpEF

T2 - A case-control substudy from the HFpEF stress trial

AU - Backhaus, Sören J.

AU - Uzun, Harun

AU - Rösel, Simon F.

AU - Schulz, Alexander

AU - Lange, Torben

AU - Crawley, Richard J.

AU - Evertz, Ruben

AU - Hasenfuß, Gerd

AU - Schuster, Andreas

N1 - Funding Information: The study received funding from and was carried out using clinical-scientific infrastructure of the DZHK ( German Centre for Cardiovascular Research ). The DZHK had no role in study design, data collection, analyses or interpretation as well as writing of reports. Funding Information: German Centre for Cardiovascular Research (DZHK).Exercise-stress was conducted using supine bicycle ergometry. At an average rotation speed of 50–60 rotations per minute, a 5 Watt increasing ramp protocol was used to stress patients, until an average heart rate of 100 beats/min was achieved before starting data acquisition. If necessary, the workload was adjusted to maintain heart rates between 100 and 110 beats/min. Hemodynamic changes (blood pressure and heart rate) at rest and during exercise-stress are given in Table S1. Data acquisition was performed in stable sinus rhythm only. HFpEF was defined based on elevated pulmonary capillary wedge pressures (PCWP) of ≥15 mmHg at rest or ≥25 mmHg during exercise-stress RHC assessments according to current guideline recommendations.8 Otherwise patients were classified as non-cardiac dyspnoea in the absence of evidence pointing towards cardiovascular disease. A telephone follow-up consultation was conducted 24 months after initial recruitment (Fig. 1).21 Primary clinical endpoints were cardiovascular mortality and admission for congestive heart failure (cardiovascular hospitalisation (CVH)). The study was funded by the German Centre for Cardiovascular Research (DZHK-17).The study received funding from and was carried out using clinical-scientific infrastructure of the DZHK (German Centre for Cardiovascular Research). The DZHK had no role in study design, data collection, analyses or interpretation as well as writing of reports.Funding: German Centre for Cardiovascular Research (DZHK). Publisher Copyright: © 2022 The Author(s)

PY - 2022/12

Y1 - 2022/12

N2 - Background: The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. Exercise-stress testing is recommended in case of uncertainty; however, this approach is time-consuming and costly. Since preserved EF does not represent normal systolic function, we hypothesized comprehensive cardiovascular magnetic resonance (CMR) assessment of cardiac hemodynamic forces (HDF) may identify functional abnormalities in HFpEF. Methods: The HFpEF Stress Trial (DZHK-17; Clinicaltrials.gov: NCT03260621) prospectively recruited 75 patients with exertional dyspnea, preserved EF (≥50%) and signs of diastolic dysfunction (E/e’ ≥8) on echocardiography. Patients underwent rest and exercise-stress right heart catheterisation, echocardiography and CMR. The final study cohort consisted of 68 patients (HFpEF n = 34 and non-cardiac dyspnea n = 34 according to pulmonary capillary wedge pressure (PCWP)). HDF assessment included left ventricular (LV) longitudinal, systolic peak and impulse, systolic/diastolic transition, E-wave deceleration as well as A-wave acceleration forces. Follow-up after 24 months evaluated cardiovascular mortality and hospitalisation (CVH) – only two patients were lost to follow-up. Findings: HDF assessment revealed impairment of LV longitudinal function in patients with HFpEF compared to non-cardiac dyspnoea (15.8% vs. 18.3%, p = 0.035), attributable to impairment of systolic peak (38.6% vs 51.6%, p = 0.003) and impulse (20.8% vs. 24.5%, p = 0.009) forces as well as late diastolic filling (−3.8% vs −5.4%, p = 0.029). Early diastolic filling was impaired in HFpEF patients identified at rest compared with patients identified during stress only (7.7% vs. 9.9%, p = 0.004). Impaired systolic peak was associated with CVH (HR 0.95, p = 0.016), and was superior to LV global longitudinal strain assessment in prediction of CVH (AUC 0.76 vs. 0.61, p = 0.048). Interpretation: Assessment of HDF indicates impairment of LV systolic ejection force in HFpEF which is associated with cardiovascular events. Funding: German Centre for Cardiovascular Research (DZHK).

AB - Background: The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. Exercise-stress testing is recommended in case of uncertainty; however, this approach is time-consuming and costly. Since preserved EF does not represent normal systolic function, we hypothesized comprehensive cardiovascular magnetic resonance (CMR) assessment of cardiac hemodynamic forces (HDF) may identify functional abnormalities in HFpEF. Methods: The HFpEF Stress Trial (DZHK-17; Clinicaltrials.gov: NCT03260621) prospectively recruited 75 patients with exertional dyspnea, preserved EF (≥50%) and signs of diastolic dysfunction (E/e’ ≥8) on echocardiography. Patients underwent rest and exercise-stress right heart catheterisation, echocardiography and CMR. The final study cohort consisted of 68 patients (HFpEF n = 34 and non-cardiac dyspnea n = 34 according to pulmonary capillary wedge pressure (PCWP)). HDF assessment included left ventricular (LV) longitudinal, systolic peak and impulse, systolic/diastolic transition, E-wave deceleration as well as A-wave acceleration forces. Follow-up after 24 months evaluated cardiovascular mortality and hospitalisation (CVH) – only two patients were lost to follow-up. Findings: HDF assessment revealed impairment of LV longitudinal function in patients with HFpEF compared to non-cardiac dyspnoea (15.8% vs. 18.3%, p = 0.035), attributable to impairment of systolic peak (38.6% vs 51.6%, p = 0.003) and impulse (20.8% vs. 24.5%, p = 0.009) forces as well as late diastolic filling (−3.8% vs −5.4%, p = 0.029). Early diastolic filling was impaired in HFpEF patients identified at rest compared with patients identified during stress only (7.7% vs. 9.9%, p = 0.004). Impaired systolic peak was associated with CVH (HR 0.95, p = 0.016), and was superior to LV global longitudinal strain assessment in prediction of CVH (AUC 0.76 vs. 0.61, p = 0.048). Interpretation: Assessment of HDF indicates impairment of LV systolic ejection force in HFpEF which is associated with cardiovascular events. Funding: German Centre for Cardiovascular Research (DZHK).

KW - Cardiovascular magnetic resonance

KW - Deformation imaging

KW - Hemodynamic force

KW - HFpEF

KW - Strain

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DO - 10.1016/j.ebiom.2022.104334

M3 - Article

C2 - 36423376

AN - SCOPUS:85142180942

SN - 2352-3964

VL - 86

JO - EBioMedicine

JF - EBioMedicine

M1 - 104334

ER -

Hemodynamic force assessment by cardiovascular magnetic resonance in HFpEF: A case-control substudy from the HFpEF stress trial

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