Real-time Cardiovascular Magnetic Resonance Imaging for Non-Invasive Characterisation of Heart Failure with Preserved Ejection Fraction: Final Outcomes of the HFpEF Stress Trial

Sören Jan Backhaus (Göttingen)1, A. Schulz (Göttingen)1, T. Lange (Göttingen)1, L. Schmidt-Schweda (Göttingen)1, R. Evertz (Göttingen)1, J. Kowallick (Göttingen)2, G. Hasenfuß (Göttingen)1, A. Schuster (Göttingen)1

1Universitätsmedizin Göttingen Herzzentrum, Klinik für Kardiologie und Pneumologie Göttingen, Deutschland; 2Universitätsmedizin Göttingen Institut Diagnostische und Interventionelle Radiologie Göttingen, Deutschland


The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. Recently, the HFpEF Stress Trial demonstrated feasibility and accuracy of non-invasive cardiovascular magnetic resonance (CMR) real-time exercise-stress atrial function imaging for early identification of HFpEF. However, no outcome data has yet been presented.

The HFpEF Stress Trial (DZHK-17) prospectively recruited 75 patients with dyspnea on exertion and echocardiographic preserved EF and signs of diastolic dysfunction (E/e’>8). 68 patients entered the final study cohort and were characterized as HFpEF (n=34) or non-cardiac dyspnea (n=34) according to pulmonary capillary wedge pressure (HFpEF: PCWP rest: ≥15mmHg stress: ≥25mmHg). These patients were contacted by telephone and hospital charts were reviewed. The clinical endpoint was cardiovascular hospitalisation (CVH).

Follow-up was performed after 48 months; 1 patient was lost to follow-up. HFpEF patients were more frequently hospitalised compared to non-cardiac dyspnea (15 vs. 8, p=0.059). Hospitalised patients during follow-up had higher H2FPEF scores (5 vs. 3, p<0.001), and impaired left atrial (LA) function at rest (p≤0.002) and stress (p≤0.006). Impairment of CMR-derived atrial function parameters at rest and during exercise-stress (p≤0.003) was associated with increased likelihood for CVH. CMR-FT LA Es/Ee (p=0.016/0.017) and RT-CMR derived LAS (p=0.003) were predictors of CVH independent of the presence of atrial fibrillation.

Left atrial function emerged as the strongest predictor for 4-year-outcome in the HFpEF Stress Trial. A combination of rest and exercise-stress LA function quantification allows accurate diagnostic and prognostic stratification in HFpEF.

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