Classification of Imaging Phenotypes of Heart Failure with Preserved Ejection Fraction (HFpEF) on MRI

摘要

Objective: The purpose of this study was to define imaging phenotypes of patients of HFpEF by the use of Cardiac MR techniques after initial evaluation with color Doppler examination. HFpEF is a common type of heart failure in the middle age with a high 5 year mortality. Diagnosis of HFpEF is based on combination of findings of colour Doppler echocardiograpy and serum NT- pro BNP levels. So far it has not been possible to identify imaging phenotypes of HFpEF which can improve patient management by use of imaging. Methods: Retrospective study of 50 patients of HFpEF who were investigated by cardiac MR using T1 mapping, extracellular estimation of left and right ventricle along with feature tracking to determine the systolic and diastolic strain of both the left and right ventricle. All patients were classified into three groups on the basis of findings observed. Results: The study showed three groups of patients. 21 patients in group I were HFpEF-iLV type with reduced GCSe'r alongwith increased E/GCSe'r values and showed no structural change. Group II (HFpEF-IpcPH type) had 13 patients which showed reduced EGCSe'r of left ventricle alongwith mild increased LAVI but also had reduced GCS of right ventricle with no structural change in latter. Group III (HFpEF-CPCPH) had 16 patients which alongwith findings of group III showed increased ECV of right ventricle. Strong correlation of E/GCSe'r was seen with proBNP levels in group III patients and with right ventricle ECV. E/GCSe'r was a strong marker in all the three groups with right ventricle ECV to decide the phenotype of patient. Conclusion: CMR was found to be useful in categorizing imaging phenotypes of HFpEF which can have a strong bearing in the management of such patients.