In patients with or at-risk for heart failure, elevated CMR-derived lung water density (>20.8%) independently predicted a composite of death, cardiovascular hospitalization, or emergency department visit at 1 year (HR 2.4).
Cohort (n=275)
Blinded interpreters
No
Does elevated CMR-derived lung water density predict death or cardiovascular events in patients with or at-risk for heart failure?
CMR-derived lung water density is a feasible, non-invasive metric that correlates with invasive filling pressures and independently predicts 1-year cardiovascular events in patients with or at risk for heart failure.
Hazard Ratio: 2.4 (95% CI 1.1–5.1)
Absolute Event Rate: 29% vs 13%
p-value: p=0.03
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.
Thompson et al. (Tue,) conducted a cohort in Heart failure (n=275). Elevated lung water density (>20.8%) vs. Normal lung water density (≤20.8%) was evaluated on Composite of death, cardiovascular hospitalization, or cardiovascular emergency department visit within 1 year (HR 2.4, 95% CI 1.1-5.1, p=0.03). In patients with or at-risk for heart failure, elevated CMR-derived lung water density (>20.8%) independently predicted a composite of death, cardiovascular hospitalization, or emergency department visit at 1 year (HR 2.4).