Prognostic value of pulmonary blood volume by first-pass contrast-enhanced CMR in heart failure outpatients: the PROVE-HF study

Abstract Background Assessment of congestion and cardiac function has been shown to have both therapeutic and prognostic implication for the management of patient with CHF. Pulmonary transit time (PTT) assessed by cMR is a novel parameter, which reflects not only hemodynamic congestion but also LV and RV function. Purpose We sought to explore the prognostic value of the pulmonary transit time assessed in seconds (PTT) and in beats (PTB) and the pulmonary blood volume indexed (PBVi) above conventional well-known risk factors including cMR-RVEF and estimated pulmonary artery pressure (eSPAP) in predicting outcomes. PBVi is defined by the product of PTB and the stroke volume indexed to body surface area. Methods 401 patients in sinus rhythm with a LVEF <35% (age 61±13 years; 25% female) underwent a cMR and an echocardiography. Patients were followed for a primary endpoint of overall mortality. Results Average cMR-LVEF was 23±7%, cMR-RVEF was 43±15%, average estimated systolic pulmonary pressure (eSPAP) was 33±12mmH, average PTT was 11±6s, PTB 8.9±5.6 bpm and average PBVi 305.5±254.9ml/m2. After a median follow-up of 6 years, 182 reached the primary endpoint. In univariate cox regression, age, ischemic cardiomyopathy, hypertension, diabetes, NYHA class III-IV, eSPAP >40mmHg, E/A ratio, e/e'ratio, cMR-RVEF, LV scar, PTT, PTB, PBVi, GFR, beta blockers and diuretics were associated with overall mortality. For the multivariate analysis, a baseline model was created where age, ischemic etiology, NYHA functional class III-IV, eSPAP >40 mmHg, beta-blockers and cMR-RVEF were found to be significantly and independently associated with the primary endpoint. PTT (X2 to improve = 5.3, HR: 1.03; 95% CI: [1.01; 1.06]; P=0.015), PTB (X2 to improve = 11.8, HR: 1.06; 95% CI: [1.03; 1.09]; P<0.001) and PBVi (X2 to improve = 7.7, HR: 1.08; 95% CI: [1.03; 1.14]; P=0.002) showed a significantly additional prognostic value over the baseline model (p<0.001). Conclusion Pulmonary transit time and pulmonary blood volume provide higher prognostic information over well-known risk factors including cMR-RVEF and eSPAP with high power to stratify prognosis in HF-rEF and might be promising tools to identify patients at higher risk among HF patients. Acknowledgement/Funding Fond National de recherche scientifique (FNRS)

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Pulmonary Blood Volume in Congestive Heart Failure

Circulation ◽

10.1161/01.cir.34.2.249 ◽

1966 ◽

Vol 34 (2) ◽

pp. 249-259 ◽

Cited By ~ 9

Author(s):

B. F. SCHREINER ◽

G. W. MURPHY ◽

P. N. YU

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Blood Volume ◽

Pulmonary Blood Volume

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Pulmonary Blood Volume Variation Decreases after Myocardial Infarction in Pigs: A Quantitative and Noninvasive MR Imaging Measure of Heart Failure

Radiology ◽

10.1148/radiol.10090292 ◽

2010 ◽

Vol 256 (2) ◽

pp. 415-423 ◽

Cited By ~ 18

Author(s):

Martin Ugander ◽

Mikael Kanski ◽

Henrik Engblom ◽

Matthias Götberg ◽

Göran K. Olivecrona ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Mr Imaging ◽

Blood Volume ◽

Pulmonary Blood Volume ◽

Volume Variation

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Simultaneous mapping of blood volume and endothelial permeability surface area product in gliomas using iterative analysis of first-pass dynamic contrast enhanced MRI data

British Journal of Radiology ◽

10.1259/bjr/31662734 ◽

2003 ◽

Vol 76 (901) ◽

pp. 39-51 ◽

Cited By ~ 48

Author(s):

K L Li ◽

X P Zhu ◽

D R Checkley ◽

J J L Tessier ◽

V F Hillier ◽

...

Keyword(s):

Surface Area ◽

Blood Volume ◽

Endothelial Permeability ◽

Dynamic Contrast Enhanced ◽

Contrast Enhanced ◽

Permeability Surface ◽

Iterative Analysis ◽

First Pass ◽

Area Product ◽

Contrast Enhanced Mri

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Continuous recording of pulmonary blood volume: pulmonary pressure and volume changes

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1959.197.5.959 ◽

1959 ◽

Vol 197 (5) ◽

pp. 959-962 ◽

Cited By ~ 13

Author(s):

Arthur W. Lindsey ◽

Arthur C. Guyton

Keyword(s):

Heart Failure ◽

Pulmonary Artery ◽

Chest Wall ◽

Blood Volume ◽

Right Heart Failure ◽

Continuous Recording ◽

Lung Field ◽

Left Heart ◽

Left Heart Failure ◽

Pulmonary Blood Volume

A method for continuous recording of pulmonary blood volume in the intact animal has been devised, utilizing the detection of I131-tagged blood from a circumscribed portion of lung field. To rule out the interference of blood in the chest wall the counts per minute (cpm) obtained from the chest wall after removing the lung at the end of the experiment were subtracted from the recorded cpm throughout the experiment. The cpm from the chest wall were found to be stable, so that it was concluded that changes in total cpm were caused by changes in pulmonary blood volume. Constriction of the ascending aorta or pulmonary artery by previously placed loops of plastic tubing produced either right or left heart failure. When left heart failure was produced acutely, the pulmonary blood volume increased an average of 79.5%±6.1 S.E. in 23 dogs. Constriction of the pulmonary artery, producing acute right heart failure, decreased the pulmonary blood volume an average of 38%±2.3 S.E. in 23 dogs.

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Increased pulmonary blood volume variation in patients with heart failure compared to healthy controls: a noninvasive, quantitative measure of heart failure

Journal of Applied Physiology ◽

10.1152/japplphysiol.00507.2019 ◽

2020 ◽

Vol 128 (2) ◽

pp. 324-337

Author(s):

Mariam Al-Mashat ◽

Jonas Jögi ◽

Marcus Carlsson ◽

Rasmus Borgquist ◽

Ellen Ostenfeld ◽

...

Keyword(s):

Heart Failure ◽

Phase Shift ◽

Pulmonary Artery ◽

Blood Volume ◽

Main Pulmonary Artery ◽

Left Ventricular ◽

Healthy Controls ◽

Pulmonary Blood Volume ◽

Volume Variation ◽

Patients With Heart Failure

Variation of the blood content of the pulmonary vascular bed during a heartbeat can be quantified by pulmonary blood volume variation (PBVV) using magnetic resonance imaging (MRI). The aim was to evaluate whether PBVV differs in patients with heart failure compared with healthy controls and investigate the mechanisms behind the PBVV. Forty-six patients and 10 controls underwent MRI. PBVV was calculated from blood flow measurements in the main pulmonary artery and a pulmonary vein, defined as the maximum difference in cumulative PBV over one heartbeat. PBVV was indexed to stroke volume (SV) in the main pulmonary artery (PBVVSV). Patients displayed higher PBVVSV than controls (58 ± 14 vs. 43 ± 7%, P < 0.001). The change in PBVVSV could be explained by left ventricular (LV) longitudinal contribution to SV ( R2 = 0.15, P = 0.02) and the phase shift between in- and outflow ( R2 = 0.31, P < 0.001) in patients. Both variables contributed to the multiple regression analysis model and predicted PBVVSV ( R2 = 0.38); however, the phase shift alone explained ~30% of the variation in PBVVSV. No correlation was found between PBVVSV and large vessel area. In conclusion, PBVVSV was higher in patients compared with controls. Approximately 40% of the variation of PBVVSV in patients can be explained by the LV longitudinal contribution to SV and the phase shift between pulmonary in- and outflow, where the phase shift alone accounts for ~30%. The remaining variation (60–70%) most likely occurs on a small vessel level. Future studies are needed to show the clinical added value of PBVVSV compared with right-heart catheterization. NEW & NOTEWORTHY This study shows that the pulmonary blood volume variation indexed to the stroke volume is higher in patients with heart failure compared with controls. The mechanisms behind this are lack of systolic suction from the left ventricular atrioventricular plane descent and increased phase shift between the in- and outflow to the pulmonary circulation (~40%), where the phase shift alone accounts for ~30%. The remaining variation (60–70%) is suggested to occur on a small vessel level.

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