Pulmonary proton density mapping and cardiac 31P MRS suggest an energetic basis for exercise-induced pulmonary congestion in HFpEF
Jack J. Miller1,2,3, Matthew K Burrage2, Moritz Hundertmark2, Ladislav Valkovič2,4, William D Watson2, Jennifer Rayner2, Nikant Sabharwal5, Vanessa M Ferreira2, Stefan Neubauer2,5, Oliver J Rider2,5, and Andrew J Lewis2,5
1Aarhus University, Aarhus, Denmark, 2OCMR (Oxford Center for Clinical Magnetic Resonance Research), University of Oxford, Oxford, United Kingdom, 3Department of Physics, University of Oxford, Oxford, United Kingdom, 4Department of Imaging Methods, Slovak Academy of Sciences, Bratislava, Slovakia, 5Department of Cardiology, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
We show in 43 patients with 31P MRS, 1H CMR and a novel proton-density mapping sequence that a gradient of myocardial energetic impairment exists across a spectrum of HFpEF phenotypes of increasing clinical severity and worsening diastolic function. A greater degree of myocardial energetic deficit is linked to impaired LV systolic and diastolic functional reserve, to altered RV reserve and RV-PA coupling, and to exercise-induced pulmonary congestion assessed using novel proton density magnetic resonance imaging. A subgroup of HFpEF patients demonstrate transient pulmonary congestion during exercise which can be non-invasively assessed using exercise CMR and proton density mapping.
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