Heart Failure with Normal Natriuretic Peptide Levels and Preserved Ejection Fraction: A Prospective Clinical and Cardiac MRI Study.

IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Radiology. Cardiothoracic imaging Pub Date : 2024-06-01 DOI:10.1148/ryct.230281
Jian He, Wenjing Yang, Weichun Wu, Gang Yin, Baiyan Zhuang, Jing Xu, Di Zhou, Jian Zhang, Yining Wang, Leyi Zhu, Xiaoxin Sun, Arlene Sirajuddin, Zhongzhao Teng, Faraz Kureshi, Andrew E Arai, Shihua Zhao, Minjie Lu
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Abstract

Purpose To describe the clinical presentation, comprehensive cardiac MRI characteristics, and prognosis of individuals with predisposed heart failure with preserved ejection fraction (HFpEF). Materials and Methods This prospective cohort study (part of MISSION-HFpEF [Multimodality Imaging in the Screening, Diagnosis, and Risk Stratification of HFpEF]; NCT04603404) was conducted from January 1, 2019, to September 30, 2021, and included individuals with suspected HFpEF who underwent cardiac MRI. Participants who had primary cardiomyopathy and primary valvular heart disease were excluded. Participants were split into a predisposed HFpEF group, defined as HFpEF with normal natriuretic peptide levels based on an HFA-PEFF (Heart Failure Association Pretest Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, and Final Etiology) score of 4 from the latest European Society of Cardiology guidelines, and an HFpEF group (HFA-PEFF score of ≥ 5). An asymptomatic control group without heart failure was also included. Clinical and cardiac MRI-based characteristics and outcomes were compared between groups. The primary end points were death, heart failure hospitalization, or stroke. Results A total of 213 participants with HFpEF, 151 participants with predisposed HFpEF, and 100 participants in the control group were analyzed. Compared with the control group, participants with predisposed HFpEF had worse left ventricular remodeling and function and higher systemic inflammation. Compared with participants with HFpEF, those with predisposed HFpEF, whether obese or not, were younger and had higher plasma volume, lower prevalence of atrial fibrillation, lower left atrial volume index, and less impaired left ventricular global longitudinal strain (-12.2% ± 2.8 vs -13.9% ± 3.1; P < .001) and early-diastolic global longitudinal strain rate (eGLSR, 0.52/sec ± 0.20 vs 0.57/sec ± 0.15; P = .03) but similar prognosis. Atrial fibrillation occurrence (hazard ratio [HR] = 3.90; P = .009), hemoglobin level (HR = 0.94; P = .001), and eGLSR (per 0.2-per-second increase, HR = 0.28; P = .002) were independently associated with occurrence of primary end points in participants with predisposed HFpEF. Conclusion Participants with predisposed HFpEF showed relatively unique clinical and cardiac MRI features, warranting greater clinical attention. eGLSR should be considered as a prognostic factor in participants with predisposed HFpEF. Keywords: Heart Failure with Preserved Ejection Fraction, Normal Natriuretic Peptide Levels, Cardiovascular Magnetic Resonance, Myocardial Strain, Prognosis Clinical trial registration no. NCT04603404 Supplemental material is available for this article. © RSNA, 2024.

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钠尿肽水平正常而射血分数保留的心力衰竭:一项前瞻性临床和心脏磁共振成像研究
目的 描述射血分数保留型心力衰竭(HFpEF)患者的临床表现、心脏磁共振成像综合特征和预后。材料与方法 该前瞻性队列研究(MISSION-HFpEF [多模态成像在 HFpEF 筛查、诊断和风险分层中的应用] 的一部分;NCT04603404)于 2019 年 1 月 1 日至 2021 年 9 月 30 日进行,纳入了接受心脏 MRI 检查的疑似 HFpEF 患者。患有原发性心肌病和原发性瓣膜性心脏病的参与者被排除在外。参试者被分为易患 HFpEF 组和 HFpEF 组(HFA-PEFF(心衰协会试验前评估、超声心动图和钠尿肽、功能测试和最终病因学)评分为 4 分),前者的定义是钠尿肽水平正常的 HFpEF,后者的定义是最新欧洲心脏病学会指南中的 HFA-PEFF(心衰协会试验前评估、超声心动图和钠尿肽、功能测试和最终病因学)评分为 4 分。此外还包括一个无症状、无心衰的对照组。对各组的临床特征和基于心脏磁共振成像的特征及结果进行了比较。主要终点为死亡、心衰住院或中风。结果 共分析了 213 名高频心衰患者、151 名易患高频心衰的患者和 100 名对照组患者。与对照组相比,易患 HFpEF 的参与者左心室重塑和功能较差,全身炎症较高。与 HFpEF 患者相比,易患 HFpEF 的患者,无论是否肥胖,都更年轻,血浆容量更高,心房颤动发生率更低,左心房容积指数更低,左心室整体纵向应变受损程度更轻(-12.2% ± 2.8 vs -13.9% ± 3.1;P < .001)和舒张早期整体纵向应变率(eGLSR,0.52/秒 ± 0.20 vs 0.57/秒 ± 0.15;P = .03)受损较轻,但预后相似。心房颤动发生率(危险比 [HR] = 3.90;P = .009)、血红蛋白水平(HR = 0.94;P = .001)和 eGLSR(每增加 0.2 秒,HR = 0.28;P = .002)与易患高频心房颤动患者的主要终点发生率独立相关。结论 易患 HFpEF 的参试者表现出相对独特的临床和心脏磁共振成像特征,值得临床进一步关注。关键词射血分数保留型心力衰竭 正常钠尿肽水平 心血管磁共振 心肌应变 预后 临床试验注册号:NCT04603404本文有补充材料。© RSNA, 2024.
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