Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Br J Radiol. 2023 Jun 1;96(1146):20220723. doi: 10.1259/bjr.20220723. Epub 2023 Apr 12.
Pulmonary congestion is a central feature of heart failure (HF) seen in acute decompensated state as well as in chronic stable disease. The present study sought to determine whether simplified cardiac magnetic resonance imaging (CMR)-derived lung water density (LWD) measurement has prognostic relevance in predicting adverse cardiovascular outcomes in patients with HF and left ventricular ejection fraction (LVEF)<50%.
Eighty consecutive patients referred for CMR with HF and LVEF<50% along with 22 healthy age- and sex-matched controls were prospectively recruited. LWD was the lung-to-liver signal intensity ratio multiplied by 70% (estimated hepatic water density). The primary endpoint was composite of all-cause mortality or HF-related hospitalization within 6 months from CMR.
The mean LWD was significantly higher in HF patients compared to healthy controls (19.78 ± 6.1 13.6 ± 2.3; < 0.001). The mean LWD was significantly different among patients with NYHA class I/II and NYHA class III/IV (17.88 ± 4.8 21.77 ± 1.08; = 0.004). At 6 months, the primary endpoint was reached in 12 (15%) patients. Patients with "wet lungs" (LWD > 18.1%) had higher incidence of adverse cardiovascular outcomes compared to patients with "dry lungs". LWD was an independent predictor of adverse cardiovascular outcomes in multivariable analysis. At the optimal cut-off of LWD > 23.38%, the sensitivity and specificity were 91.67 and 91.18%, respectively, to predict adverse cardiovascular outcomes.
LWD on CMR is independently associated with increased risk of mortality and HF-related hospitalization in HF patients with LVEF<50%.
Non-invasive quantitative estimation of LWD on CMR can improve risk stratification and guide management in HF patients.
肺淤血是心力衰竭（HF）的一个核心特征，无论是在急性失代偿期还是慢性稳定期都可见到。本研究旨在确定简化心脏磁共振成像（CMR）衍生的肺水密度（LWD）测量在预测射血分数<50%的 HF 患者不良心血管结局方面是否具有预后相关性。
前瞻性招募了 80 例因 HF 且射血分数<50%而行 CMR 的连续患者和 22 例年龄和性别匹配的健康对照者。LWD 是肺与肝的信号强度比值乘以 70%（估计的肝水密度）。主要终点是从 CMR 后 6 个月内的全因死亡率或 HF 相关住院的复合终点。
HF 患者的平均 LWD 明显高于健康对照组（19.78±6.1 vs. 13.6±2.3；<0.001）。NYHA Ⅰ/Ⅱ级和 NYHA Ⅲ/Ⅳ级患者的平均 LWD 也有显著差异（17.88±4.8 vs. 21.77±1.08；=0.004）。在 6 个月时，12 名（15%）患者达到了主要终点。与“干肺”（LWD<18.1%）患者相比，“湿肺”（LWD>18.1%）患者发生不良心血管结局的发生率更高。LWD 在多变量分析中是不良心血管结局的独立预测因子。在 LWD>23.38%的最佳截断值时，预测不良心血管结局的敏感性和特异性分别为 91.67%和 91.18%。
在射血分数<50%的 HF 患者中，CMR 上的 LWD 与死亡率和 HF 相关住院率增加独立相关。
CMR 上非侵入性定量估计 LWD 可以改善 HF 患者的风险分层并指导其管理。
