In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.


The free consultation period for this content is over.

It is now only available year-round to EACVI Silver Members, Fellows of the ESC and Young combined Members

Defining the phenotype of heart failure with mid-range ejection fraction by cardiovascular magnetic resonance

Session Poster session 1

Speaker Louise Brown

Congress : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Systolic and Diastolic Function
  • Session type : Poster Session
  • FP Number : P151

Authors : L Brown (Leeds,GB), CED Saunderson (Leeds,GB), A Das (Leeds,GB), T Craven (Leeds,GB), H Xue (Bethesda,US), K Knott (London,GB), E Levelt (Leeds,GB), J Moon (London,GB), E Dall'armellina (Leeds,GB), JP Greenwood (Leeds,GB), P Kellman (Bethesda,US), S Plein (Leeds,GB), PP Swoboda (Leeds,GB)

Authors:
L Brown1 , CED Saunderson1 , A Das1 , T Craven1 , H Xue2 , K Knott3 , E Levelt1 , J Moon3 , E Dall'armellina1 , JP Greenwood1 , P Kellman2 , S Plein1 , PP Swoboda1 , 1University of Leeds - Leeds - United Kingdom of Great Britain & Northern Ireland , 2National Institutes of Health - Bethesda - United States of America , 3Barts Health NHS Trust - London - United Kingdom of Great Britain & Northern Ireland ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii100

Background 

The 2016 ESC Heart Failure Guidelines introduced the term of Heart Failure with mid-range ejection fraction (HFmrEF) for patients with an ejection fraction between 40 and 49%. This group was identified as lacking information about characteristics, pathophysiology and treatment and was highlighted as a priority for research. 

Purpose 

We aimed to characterise HFmrEF demographic and CMR imaging characteristics, comparing to those of heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).  

Methods 

We prospectively recruited 200 patients with heart failure of unknown origin and no symptoms or history of coronary disease.  Patients underwent clinical assessment, haematocrit assessment and adenosine stress perfusion CMR (Siemens 3T with Gadgetron) including inline T1 mapping, myocardial blood flow (MBF) mapping and late gadolinium enhancement.  Patients with inducible regional ischaemia or myocardial infarction (n=38) were excluded from further analysis. 

Results 

Patients with HFmrEF were more commonly female and used less diuretic compared to HFrEF. The cardiac phenotype of HFmrEF was of intermediate (HFpEF < HFmrEF < HFrEF) left ventricular (LV) indexed end diastolic volume, native T1 and ECV. Stress MBF and myocardial perfusion reserve were higher in HFmrEF compared to HFrEF while LV indexed mass was reduced; there was no significant difference to HFpEF.

Conclusions 

Patients with HFmrEF have intermediate tissue characteristics compared with HFpEF and HFrEF. Myocardial perfusion in HFmrEF is preserved compared with HFrEF. These findings help understand differences in pathophysiology and suggest treatment options for these 3 groups.

HFpEF

n=38

HFmrEF

n=48

HFrEF

n=76

p
Age (years) 62.3±11.8 61.6±13.4 65.1±11.9 0.25
Female (%) 55.3 47.9 19.7 <0.01
NYHA (%) I 63.2 56.3 51.3
II 31.6 37.5 36.8 0.61
III 5.3 6.3 11.8
ACE inhibitor/Angiotensin receptor blocker use (%) 84.2 89.6 86.5 0.76
Beta blocker use (%) 73.7 77.1 77.0 0.91
Diuretic use (%) 28.9 37.5 59.5 <0.01
Mineralocorticoid receptor antagonist use (%) 21.1 14.6 28.4 0.20
% Change in rate-pressure product (bpm.mmHg) 22.8±25.9 25.5±29.7 15.0±28.3 0.08
Late Gadolinium enhancement present (%) 21.1 33.3 43.4 0.06
Baseline characteristics by heart failure type.


Based on your interests

Members get more

Join now
  • 1ESC Professional Members – access all resources from ESC Congress and ESC Asia with APSC & AFC
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s congress resources
  • 3Under 40 or in training - with a Combined Membership, access resources from all congresses
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are