Classification of Imaging Phenotypes of Heart Failure with Preserved Ejection Fraction (HFpEF) on MRI

Atul Kapoor; Aprajita Kapoor; Goldaa Mahajan

doi:doi:10.11648/j.ccr.20200404.14

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Classification of Imaging Phenotypes of Heart Failure with Preserved Ejection Fraction (HFpEF) on MRI

Atul Kapoor, Aprajita Kapoor, Goldaa Mahajan

Published in Cardiology and Cardiovascular Research (Volume 4, Issue 4)

Received: 3 October 2020 Accepted: 15 October 2020 Published: 21 October 2020

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Abstract

Objective: The purpose of this study was to define imaging phenotypes of patients of HFpEF by the use of Cardiac MR techniques after initial evaluation with color Doppler examination. HFpEF is a common type of heart failure in the middle age with a high 5 year mortality. Diagnosis of HFpEF is based on combination of findings of colour Doppler echocardiograpy and serum NT- pro BNP levels. So far it has not been possible to identify imaging phenotypes of HFpEF which can improve patient management by use of imaging. Methods: Retrospective study of 50 patients of HFpEF who were investigated by cardiac MR using T1 mapping, extracellular estimation of left and right ventricle along with feature tracking to determine the systolic and diastolic strain of both the left and right ventricle. All patients were classified into three groups on the basis of findings observed. Results: The study showed three groups of patients. 21 patients in group I were HFpEF-iLV type with reduced GCSe’r alongwith increased E/GCSe’r values and showed no structural change. Group II (HFpEF –IpcPH type) had 13 patients which showed reduced EGCSe’r of left ventricle alongwith mild increased LAVI but also had reduced GCS of right ventricle with no structural change in latter. Group III (HFpEF-CPCPH) had 16 patients which alongwith findings of group III showed increased ECV of right ventricle. Strong correlation of E/GCSe’r was seen with proBNP levels in group III patients and with right ventricle ECV. E/GCSe’r was a strong marker in all the three groups with right ventricle ECV to decide the phenotype of patient. Conclusion: CMR was found to be useful in categorizing imaging phenotypes of HFpEF which can have a strong bearing in the management of such patients.

Published in	Cardiology and Cardiovascular Research (Volume 4, Issue 4)
DOI	10.11648/j.ccr.20200404.14
Page(s)	187-195
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

HFpEF, Cardiac MR, Diastolic Dysfunction, Extracellular Volume

References

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[2]	Loehr LR, Rosamond WD, Chang PP, Folsom AR, Chambless LE. Heart failure incidence and survival (from the Atherosclerosis Risk in Communities study) Am J Cardiol. 2008; 101: 1016–22.
[3]	Pieske B, Schöpe CT, Boer RA, Fraser AG, Anker SD, Donal E, Edelmann F, Fu M, Guazzi M etal. How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) European Heart Journal 2019; 40: 3297–3317.
[4]	Samson R, Jaiswal A, Ennezat PV, Cassidy M; e Jemtel TL. Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction. JAHA 2016; 115: 1-15.
[5]	Pasha MC, Zhan Y, Debs D, Shah DJ. CMR in the evaluation of diastolic dysfunction and phenotyping HFpEF. JACC. Cardiovascular imaging 2020; 113: 283-296.
[6]	Patel Rm, Li E, Brandon C, Stanley A, Benefield, Vincenzo B etal. Diffuse right ventricular fibrosis in heart failure with preserved ejection fraction and pulmonary hypertension. ESC Heart failure. 2020; 7: 254-264.
[7]	Borlaug BA. The pathophysiology of heart failure with preserved ejection fraction Nat Rev Cardiol. 2014 Sep; 11 (9): 507-15.
[8]	Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA et al, American College of Cardiology Foundation., American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Oct 15; 62 (16): e147-239.
[9]	Mentz RJ, Kelly JP, von Lueder TG, Voors AA, Lam CS, Cowie MR, Kjeldsen K, Jankowska EA, Atar D, Butler J, Fiuzat M, Zannad F, Pitt B, O'Connor CM Non cardiac comorbidities in heart failure with reduced versus preserved ejection fraction. J Am Coll Cardiol. 2014 Dec 2; 64 (21): 2281-93.
[10]	Kalogeropoulos A, Georgiopoulou V, Psaty BM, Rodondi N, Smith AL, Harrison DG, Liu Y, Hoffmann U, Bauer DC, Newman AB, Kritchevsky SB, Harris TB, Butler J, Health ABC Study Investigators. Inflammatory markers and incident heart failure risk in older adults: the Health ABC (Health, Aging, and Body Composition) study. J Am Coll Cardiol. 2010 May 11; 55 (19): 2129-37.
[11]	Opitz CF, Hoeper MM, Gibbs JS, Kaemmerer H, Pepke-Zaba J, Coghlan JG, et al. Pre-capillary, combined, and post-capillary pulmonary hypertension: a pathophysiological continuum. J Am Coll Cardiol. 2016; 68 (4): 368–78.
[12]	Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass D. Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation. 2005 Oct 11; 112 (15): 2254-62.
[13]	Olsen FJ, Bertelsen L, de Knegt MC, et al. Multimodality cardiac imaging for the assessment of left atrial function and the association with atrial arrhythmias. Circ Cardiovasc Imaging 2016; 9: e00494.
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APA Style

Atul Kapoor, Aprajita Kapoor, Goldaa Mahajan. (2020). Classification of Imaging Phenotypes of Heart Failure with Preserved Ejection Fraction (HFpEF) on MRI. Cardiology and Cardiovascular Research, 4(4), 187-195. https://doi.org/10.11648/j.ccr.20200404.14

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ACS Style

Atul Kapoor; Aprajita Kapoor; Goldaa Mahajan. Classification of Imaging Phenotypes of Heart Failure with Preserved Ejection Fraction (HFpEF) on MRI. Cardiol. Cardiovasc. Res. 2020, 4(4), 187-195. doi: 10.11648/j.ccr.20200404.14

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AMA Style

Atul Kapoor, Aprajita Kapoor, Goldaa Mahajan. Classification of Imaging Phenotypes of Heart Failure with Preserved Ejection Fraction (HFpEF) on MRI. Cardiol Cardiovasc Res. 2020;4(4):187-195. doi: 10.11648/j.ccr.20200404.14

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@article{10.11648/j.ccr.20200404.14,
  author = {Atul Kapoor and Aprajita Kapoor and Goldaa Mahajan},
  title = {Classification of Imaging Phenotypes of Heart Failure with Preserved Ejection Fraction (HFpEF) on MRI},
  journal = {Cardiology and Cardiovascular Research},
  volume = {4},
  number = {4},
  pages = {187-195},
  doi = {10.11648/j.ccr.20200404.14},
  url = {https://doi.org/10.11648/j.ccr.20200404.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20200404.14},
  abstract = {Objective: The purpose of this study was to define imaging phenotypes of patients of HFpEF by the use of Cardiac MR techniques after initial evaluation with color Doppler examination. HFpEF is a common type of heart failure in the middle age with a high 5 year mortality. Diagnosis of HFpEF is based on combination of findings of colour Doppler echocardiograpy and serum NT- pro BNP levels. So far it has not been possible to identify imaging phenotypes of HFpEF which can improve patient management by use of imaging. Methods: Retrospective study of 50 patients of HFpEF who were investigated by cardiac MR using T1 mapping, extracellular estimation of left and right ventricle along with feature tracking to determine the systolic and diastolic strain of both the left and right ventricle. All patients were classified into three groups on the basis of findings observed. Results: The study showed three groups of patients. 21 patients in group I were HFpEF-iLV type with reduced GCSe’r alongwith increased E/GCSe’r values and showed no structural change. Group II (HFpEF –IpcPH type) had 13 patients which showed reduced EGCSe’r of left ventricle alongwith mild increased LAVI but also had reduced GCS of right ventricle with no structural change in latter. Group III (HFpEF-CPCPH) had 16 patients which alongwith findings of group III showed increased ECV of right ventricle. Strong correlation of E/GCSe’r was seen with proBNP levels in group III patients and with right ventricle ECV. E/GCSe’r was a strong marker in all the three groups with right ventricle ECV to decide the phenotype of patient. Conclusion: CMR was found to be useful in categorizing imaging phenotypes of HFpEF which can have a strong bearing in the management of such patients.},
 year = {2020}
}

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TY - JOUR
T1 - Classification of Imaging Phenotypes of Heart Failure with Preserved Ejection Fraction (HFpEF) on MRI
AU - Atul Kapoor
AU - Aprajita Kapoor
AU - Goldaa Mahajan
Y1 - 2020/10/21
PY - 2020
N1 - https://doi.org/10.11648/j.ccr.20200404.14
DO - 10.11648/j.ccr.20200404.14
T2 - Cardiology and Cardiovascular Research
JF - Cardiology and Cardiovascular Research
JO - Cardiology and Cardiovascular Research
SP - 187
EP - 195
PB - Science Publishing Group
SN - 2578-8914
UR - https://doi.org/10.11648/j.ccr.20200404.14
AB - Objective: The purpose of this study was to define imaging phenotypes of patients of HFpEF by the use of Cardiac MR techniques after initial evaluation with color Doppler examination. HFpEF is a common type of heart failure in the middle age with a high 5 year mortality. Diagnosis of HFpEF is based on combination of findings of colour Doppler echocardiograpy and serum NT- pro BNP levels. So far it has not been possible to identify imaging phenotypes of HFpEF which can improve patient management by use of imaging. Methods: Retrospective study of 50 patients of HFpEF who were investigated by cardiac MR using T1 mapping, extracellular estimation of left and right ventricle along with feature tracking to determine the systolic and diastolic strain of both the left and right ventricle. All patients were classified into three groups on the basis of findings observed. Results: The study showed three groups of patients. 21 patients in group I were HFpEF-iLV type with reduced GCSe’r alongwith increased E/GCSe’r values and showed no structural change. Group II (HFpEF –IpcPH type) had 13 patients which showed reduced EGCSe’r of left ventricle alongwith mild increased LAVI but also had reduced GCS of right ventricle with no structural change in latter. Group III (HFpEF-CPCPH) had 16 patients which alongwith findings of group III showed increased ECV of right ventricle. Strong correlation of E/GCSe’r was seen with proBNP levels in group III patients and with right ventricle ECV. E/GCSe’r was a strong marker in all the three groups with right ventricle ECV to decide the phenotype of patient. Conclusion: CMR was found to be useful in categorizing imaging phenotypes of HFpEF which can have a strong bearing in the management of such patients.
VL - 4
IS - 4
ER -

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Author Information

Atul Kapoor

Department of Radiology, Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India
Aprajita Kapoor

Department of Radiology, Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India
Goldaa Mahajan

Department of Radiology, Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India

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APA Style

Atul Kapoor, Aprajita Kapoor, Goldaa Mahajan. (2020). Classification of Imaging Phenotypes of Heart Failure with Preserved Ejection Fraction (HFpEF) on MRI. Cardiology and Cardiovascular Research, 4(4), 187-195. https://doi.org/10.11648/j.ccr.20200404.14

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ACS Style

Atul Kapoor; Aprajita Kapoor; Goldaa Mahajan. Classification of Imaging Phenotypes of Heart Failure with Preserved Ejection Fraction (HFpEF) on MRI. Cardiol. Cardiovasc. Res. 2020, 4(4), 187-195. doi: 10.11648/j.ccr.20200404.14

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AMA Style

Atul Kapoor, Aprajita Kapoor, Goldaa Mahajan. Classification of Imaging Phenotypes of Heart Failure with Preserved Ejection Fraction (HFpEF) on MRI. Cardiol Cardiovasc Res. 2020;4(4):187-195. doi: 10.11648/j.ccr.20200404.14

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@article{10.11648/j.ccr.20200404.14,
  author = {Atul Kapoor and Aprajita Kapoor and Goldaa Mahajan},
  title = {Classification of Imaging Phenotypes of Heart Failure with Preserved Ejection Fraction (HFpEF) on MRI},
  journal = {Cardiology and Cardiovascular Research},
  volume = {4},
  number = {4},
  pages = {187-195},
  doi = {10.11648/j.ccr.20200404.14},
  url = {https://doi.org/10.11648/j.ccr.20200404.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20200404.14},
  abstract = {Objective: The purpose of this study was to define imaging phenotypes of patients of HFpEF by the use of Cardiac MR techniques after initial evaluation with color Doppler examination. HFpEF is a common type of heart failure in the middle age with a high 5 year mortality. Diagnosis of HFpEF is based on combination of findings of colour Doppler echocardiograpy and serum NT- pro BNP levels. So far it has not been possible to identify imaging phenotypes of HFpEF which can improve patient management by use of imaging. Methods: Retrospective study of 50 patients of HFpEF who were investigated by cardiac MR using T1 mapping, extracellular estimation of left and right ventricle along with feature tracking to determine the systolic and diastolic strain of both the left and right ventricle. All patients were classified into three groups on the basis of findings observed. Results: The study showed three groups of patients. 21 patients in group I were HFpEF-iLV type with reduced GCSe’r alongwith increased E/GCSe’r values and showed no structural change. Group II (HFpEF –IpcPH type) had 13 patients which showed reduced EGCSe’r of left ventricle alongwith mild increased LAVI but also had reduced GCS of right ventricle with no structural change in latter. Group III (HFpEF-CPCPH) had 16 patients which alongwith findings of group III showed increased ECV of right ventricle. Strong correlation of E/GCSe’r was seen with proBNP levels in group III patients and with right ventricle ECV. E/GCSe’r was a strong marker in all the three groups with right ventricle ECV to decide the phenotype of patient. Conclusion: CMR was found to be useful in categorizing imaging phenotypes of HFpEF which can have a strong bearing in the management of such patients.},
 year = {2020}
}

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