Key result
MRI-assessed tissue sodium content does not differ between HFrEF, HFmrEF, and HFpEF.
Why the study?
Heart failure is influenced by sodium balance, and MRI has recently emerged as a non-invasive method to evaluate tissue sodium load, but its association with baseline parameters across HF subtypes needed investigation.
Observational (n=29)
Yes
Tissue sodium content assessed by MRI does not significantly differ across HF subtypes, but correlates with NT-proBNP in HFrEF and with renal function in edematous patients without prior loop diuretic use.
Tissue sodium content does not distinguish HF subtypes; leaves open its prognostic or therapeutic relevance in larger prospective studies.
Aims Heart failure (HF) is a complex clinical syndrome with high morbidity and mortality, influenced significantly by sodium balance. Recently, magnetic resonance imaging (MRI) has emerged as a non-invasive method to evaluate tissue sodium load in HF patients. This proof-of-principle study investigates the association between tissue sodium content, assessed by MRI, and HF-related baseline parameters in an outpatient cohort of patients with chronic heart failure, including those with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF). Methods and results This prospective study included 29 HF patients (10 HFpEF, 12 HFmrEF, and 7 HFrEF) recruited from two centers in Berlin, Germany. Patients underwent MRI to assess tissue sodium content in the lower extremity. Tissue sodium content was analyzed in relation to baseline HF parameters, including renal function, natriuretic peptide levels, clinical signs of congestion, diuretic use, and New York Heart Association (NYHA) functional class. No significant differences in tissue sodium content were observed between the three HF entities. Sodium values did not differ significantly with clinical signs of congestion or diuretic use. No significant correlations were found between tissue sodium content and renal function (eGFR) or natriuretic peptide levels (NT-proBNP) in any HF group overall. However, explorative analyses showed a positive correlation between free ( r = 0.79, p = 0.036) and total ( r = 0.79, p = 0.036) tissue sodium content in the skin and NT-proBNP levels in HFrEF patients, but not in HFmrEF and HFpEF. Similarly, there was a correlation between kidney function and both free ( r = −0.64, p = 0.025) and total (r = −0.61, p = 0.035) skin sodium in patients with edema and no prior use of loop diuretics, but no correlation for kidney function and both free and total skin sodium in symptomatic patients with established diuretic therapy or asymptomatic patients with no diuretic therapy. Conclusion Our findings provide exploratory insights into the potential diagnostic value of tissue sodium content in HF, particularly in HFrEF patients. With findings showing an association of tissue sodium content with NT-proBNP levels in HFrEF patients and with kidney function in edema patients without prior loop diuretic use, further research is needed to understand the role of tissue sodium content in HF pathophysiology and its potential diagnostic and prognostic implications. Trial registration German Clinical Trials Register (DRKS), registration number (DRKS00015615).
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Hashemi et al. (2025) conducted an observational in Chronic heart failure (HFrEF, HFmrEF, HFpEF) (n=29). 23Na magnetic resonance imaging vs. Comparison between HF subtypes (HFrEF, HFmrEF, HFpEF) was evaluated on Difference between heart failure entities regarding tissue sodium levels. Tissue sodium content assessed by magnetic resonance imaging did not differ significantly between patients with heart failure with reduced, mildly reduced, and preserved ejection fraction.
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