1Universitätsmedizin Göttingen Herzzentrum, Klinik für Kardiologie und Pneumologie Göttingen, Deutschland; 2Universitätsmedizin Göttingen Institut Diagnostische und Interventionelle Radiologie Göttingen, Deutschland
Background:
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.
Methods:
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).
Results:
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.
Conclusions:
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.