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The relationship between longitudinal function and symptoms in patients with heart failure with reduced ejection fraction

Session Poster session 1

Speaker Marcus Carlsson

Congress : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Systolic and Diastolic Function
  • Session type : Poster Session
  • FP Number : P157

Authors : J Karlsson (Lund,SE), K Solem (Lund,SE), R Jablonowski (Lund,SE), F Seeman (Lund,SE), R Borgquist (Lund,SE), E Heiberg (Lund,SE), H Arheden (Lund,SE), M Carlsson (Lund,SE)

Authors:
J Karlsson1 , K Solem2 , R Jablonowski1 , F Seeman1 , R Borgquist3 , E Heiberg1 , H Arheden1 , M Carlsson1 , 1Lund University, Department of Clinical Sciences Lund, Clinical Physiology - Lund - Sweden , 2Syntach AB - Lund - Sweden , 3Lund University, Department of Clinical Sciences Lund, Cardiology, Sweden - Lund - Sweden ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii112

Background 
Heart failure (HF) patients have poor prognosis and with an estimated 20 million patients worldwide, it is one of the most serious diseases affecting the world today. Research in this field is therefore important. The longitudinal shortening and lengthening, measured as atrioventricular plane displacement (AVPD) or mitral annular plane systolic excursion (MAPSE), have become recognized to infer additional prognostic information to ejection fraction (EF) and infarction using late gadolinium enhancement on cardiovascular magnetic resonance (CMR). New York Heart Association (NYHA) classification is a widely used tool for grading symptoms in patients with heart failure.

Purpose
Although both NYHA class and AVPD have prognostic information, comparisons of AVPD with NYHA class are missing. Therefore, the aim of this study was to relate AVPD to NYHA class in patients with heart failure with reduced ejection fraction (HFrEF). We hypothesize that with increased NYHA class there is a concomitant decreased AVPD.

Methods
144 patients with congestive HF and an EF below 40% (62±12 years, 109 male) and 20 age-matched controls (62±11 years, 12 male) were imaged using CMR. Long-axis cine images (2ch, 3ch and 4ch) were acquired and analysed using a freely available software. Results are presented as mean ± SD and differences between NYHA classes are compared with ANOVA using post hoc analysis.

Results
Subject characteristics are shown in Table 1. The mean AVPD for patients was 7.8±2.5mm and the mean NYHA classification was 2.8±0.8. There was a difference in AVPD between NYHA II (8.8±2.8 mm) and NYHA IV (6.6±1.8 mm, p=0.001, Figure 1A). AVPD for all NYHA classes were decreased compared to controls (p=<0.001). When normalizing AVPD with body surface area (BSA), there was a difference in NYHA I vs NYHA IV (p=0.03, Figure 1B) and NYHA II vs NYHA IV (p=0.006, Figure 1B). 

Conclusion.
Left ventricular AVPD is reduced in all NYHA classes and there is a small stepwise decrease in AVPD with increasing NYHA class. Future research needs to investigate whether AVPD can add additional prognostic information compared to NYHA classification.

Controls All NYHA NYHA I NYHA II NYHA III NYHA IV
Patients [n] 20 144 7 42 66 29
SV [ml] 97 ± 20 70 ± 23 72 ± 21 77 ± 20 73 ± 24 53 ± 18
EF [%] 60 ± 5 27 ± 8 32 ± 4 29 ± 8 26 ± 8 24 ± 8
CI [l/min] 3.1 ± 0.5 2.4 ± 0.7 2.5 ± 0.5 2.6 ± 0.6 2.5 ± 0.7 2.2 ± 0.6
BSA [m2] 1.9 ± 0.2 2.0 ± 0.2 1.8 ± 0.2 2.0 ± 0.2 2.0 ± 0.2 1.9 ± 0.2


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