Journal of Cardiovascular Magnetic Resonance (Sep 2019)

Quantification of lung water in heart failure using cardiovascular magnetic resonance imaging

  • Richard B. Thompson,
  • Kelvin Chow,
  • Joseph J. Pagano,
  • Viktor Sekowski,
  • Evangelos D. Michelakis,
  • Wayne Tymchak,
  • Mark J. Haykowsky,
  • Justin A. Ezekowitz,
  • Gavin Y. Oudit,
  • Jason R. B. Dyck,
  • Padma Kaul,
  • Anamaria Savu,
  • D. Ian Paterson

DOI
https://doi.org/10.1186/s12968-019-0567-y
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 11

Abstract

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Abstract Background Pulmonary edema is a cardinal feature of heart failure but no quantitative tests are available in clinical practice. The goals of this study were to develop a simple cardiovascular magnetic resonance (CMR) approach for lung water quantification, to correlate CMR derived lung water with intra-cardiac pressures and to determine its prognostic significance. Methods Lung water density (LWD, %) was measured using a widely available single-shot fast spin-echo acquisition in two study cohorts. Validation Cohort: LWD was compared to left ventricular end-diastolic pressure or pulmonary capillary wedge pressure in 19 patients with heart failure undergoing cardiac catheterization. Prospective Cohort: LWD was measured in 256 subjects, including 121 with heart failure, 82 at-risk for heart failure and 53 healthy controls. Clinical outcomes were evaluated up to 1 year. Results Within the validation cohort, CMR LWD correlated to invasively measured left-sided filling pressures (R = 0.8, p 20.8% (mean + 2 standard deviations of healthy controls) was an independent predictor of death, hospitalization or emergency department visit within 1 year, hazard ratio 2.4 (1.1–5.1, p = 0.03). Conclusions In patients with heart failure, increased CMR-derived lung water is associated with increased intra-cardiac filling pressures, and predicts 1 year outcomes. LWD could be incorporated in standard CMR scans.

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