Key result
GDMT normalizes pulmonary blood volume index in newly diagnosed HF, reducing it by ~98 ml/m2.
Why the study?
Pulmonary congestion in HF is challenging to quantify. Although CMR perfusion scans can calculate indexed pulmonary blood volume (PBVi) as a marker of congestion, whether PBVi normalizes after initiating treatment and how it differs across HF subtypes compared to healthy controls needed evaluation.
Does initiation of guideline-directed medical therapy normalize pulmonary blood volume indexed to body surface area (PBVi) measured by CMR in patients with newly diagnosed heart failure compared to healthy controls?
Cohort (n=115)
Does initiation of guideline-directed medical therapy normalize pulmonary blood volume indexed to body surface area (PBVi) measured by CMR in patients with newly diagnosed heart failure compared to healthy controls?
Non-invasive quantification of pulmonary blood volume index by CMR demonstrates normalization of pulmonary congestion following guideline-directed medical therapy in newly diagnosed heart failure, offering a potential tool to monitor decongestive treatment response.
PBVi elevation signals congestion in new HF; extends CMR perfusion quantification as a congestion marker for future validation.
Background Pulmonary congestion in heart failure (HF) is challenging to quantify. Recent advances in cardiovascular magnetic resonance (CMR) using routine clinical perfusion scans make it possible to calculate the pulmonary blood volume indexed to body surface area (PBVi) as a prognostic marker of congestion. The aims were to assess if PBVi normalizes after onset of treatment and if PBVi differs in different HF subtypes compared to healthy controls. Methods In this prospective cohort study, a total of 115 subjects (22 healthy controls, 93 HF patients of which 19 newly diagnosed) underwent CMR at 1.5T. PBVi was calculated as the transit time for a contrast bolus from the right to the left side of the heart during a perfusion scan, multiplied by the cardiac output from 2D aortic flow. Results Patients with newly diagnosed HF showed signs of pulmonary congestion in terms of an increased PBVi compared to controls (394 vs 302 ml/m2 p = 0·004). After treatment, PBVi normalized to similar levels as controls (296 ml/m2, p > 0·99). There were no differences in PBVi between controls and chronic out-patients with preserved (HFpEF, n = 19, p > 0·999), mildly reduced (HFmrEF, n = 24, p > 0·999) or reduced ejection fraction (HFrEF, n = 31, p = 0·146). Conclusion This proof-of-concept study demonstrates for the first time that non-invasive PBVi normalizes following initiation of guideline-directed medical therapy, while PBVi remained within normal range in treated patients with HFpEF or HFmrEF. Assessment by CMR may provide incremental clinical value as a marker of pulmonary congestion in suspected HF and for evaluating response to decongestive treatment.
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Nelsson et al. (2026) conducted a cohort in Heart failure (n=115). Guideline-directed medical therapy in newly diagnosed heart failure vs. Healthy controls was evaluated on Pulmonary blood volume indexed to body surface area (PBVi, ml/m2) (p=0.004). Guideline-directed medical therapy in newly diagnosed HF normalized elevated pulmonary blood volume index (from 394 to 296 ml/m2 vs 302 ml/m2 in controls, p>0.99).
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