Quick Fire Session
SCMR 22nd Annual Scientific Sessions
Background: Differences in extracellular volume fraction (ECV), but not native T1, have been shown between heart failure (HF) patients with reduced ejection fraction (EF<50%; HFrEF) or preserved ejection fraction (HFpEF)1; however, detailed comparisons between these groups, incorporating the known differences between the sexes2, to healthy controls and those at risk for heart failure would aid in our understanding of the disease spectrum.
Methods: Cardiac MRI (1.5T MAGNETOM Sonata or Avanto, Siemens Healthcare, Erlangen, Germany) was performed including cine imaging, late gadolinium enhancement (LGE), and T1 mapping using the prototype SASHA sequence,3 on prospectively recruited control subjects, subjects at risk for HF (including obesity, hypertension, diabetes, hyperlipidemia, coronary artery disease), and those with HF4. T1 and ECV were measured in the mid and/or basal interventricular septum. P-values were not corrected for multiple comparisons to preserve power.
Results: CMR studies were available in 324 individuals (66±11 years, 163 male). Characteristics of the groups, separated by sex, are presented in Table 1.
Group Differences (Native T1): For both men and women, no significant differences existed in native T1 between control subjects, those at risk for heart failure, or those with HFpEF, irrespective of the presence of LGE in the septal ROI (p>0.05 for all). Men and women with HFrEF had significantly higher native T1 than all other groups (p<0.05 for all), except between women with HFrEF and HFpEF (p=0.116). This finding persists even when excluding ROIs that contain LGE.
Group Differences (ECV): Men with HFrEF have a significantly larger ECV compared to all groups (p<0.05 for all); however, most differences are lost when ROIs that contain LGE are excluded. ECV is not different between women with HFrEF and HFpEF, even when excluding ROIs that contain LGE (p>0.05 for both). In women, both HF types have increased ECV compared to those at risk, even when excluding ROIs that contain LGE (p<0.05 for all).
Conclusion: Patients with HFrEF generally have increased T1 and ECV values compared to other groups, though differences between HF types were not consistently observed in men. This may suggest differences in fibrosis pathophysiology of HFpEF between men and women. Future study is needed to determine if this plays a role in known sex differences in cardiovascular outcomes.