Author + information
- Received March 10, 2017
- Revision received April 21, 2017
- Accepted May 4, 2017
- Published online April 2, 2018.
- Ify R. Mordi, MDa,
- Satnam Singh, MBBSb,
- Amelia Rudd, HNDb,
- Janaki Srinivasan, RCDSb,
- Michael Frenneaux, PhDb,
- Nikolaos Tzemos, MDc and
- Dana K. Dawson, DM, DPhilb,∗ ()
- aDivision of Molecular and Clinical Medicine, University of Dundee, Dundee, United Kingdom
- bSchool of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom
- cInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- ↵∗Address for correspondence:
Dr. Dana K. Dawson, School of Medicine and Dentistry, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom.
Objectives The aim of this study was to investigate the utility of a comprehensive imaging protocol including echocardiography and cardiac magnetic resonance in the diagnosis and differentiation of hypertensive heart disease and heart failure with preserved ejection fraction (HFpEF).
Background Hypertension is present in up to 90% of patients with HFpEF and is a major etiological component. Despite current recommendations and diagnostic criteria for HFpEF, no noninvasive imaging technique has as yet shown the ability to identify any structural differences between patients with hypertensive heart disease and HFpEF.
Methods We conducted a prospective cross-sectional study of 112 well-characterized patients (62 with HFpEF, 22 with hypertension, and 28 healthy control subjects). All patients underwent cardiopulmonary exercise and biomarker testing and an imaging protocol including echocardiography with speckle-tracking analysis and cardiac magnetic resonance including T1 mapping pre- and post-contrast.
Results Echocardiographic global longitudinal strain (GLS) and extracellular volume (ECV) measured by cardiac magnetic resonance were the only variables able to independently stratify among the 3 groups of patients. ECV was the best technique for differentiation between hypertensive heart disease and HFpEF (ECV area under the curve: 0.88; GLS area under the curve: 0.78; p < 0.001 for both). Using ECV, an optimal cutoff of 31.2% gave 100% sensitivity and 75% specificity. ECV was significantly higher and GLS was significantly reduced in subjects with reduced exercise capacity (lower peak oxygen consumption and higher minute ventilation–carbon dioxide production) (p < 0.001 for both ECV and GLS).
Conclusions Both GLS and ECV are able to independently discriminate between hypertensive heart disease and HFpEF and identify patients with prognostically significant functional limitation. ECV is the best diagnostic discriminatory marker of HFpEF and could be used as a surrogate endpoint for therapeutic studies.
- cardiac magnetic resonance imaging
- heart failure
- heart failure with preserved ejection fraction
- speckle tracking
- T1 mapping
Dr. Dawson has received a research agreement from Philips Healthcare; and a material transfer agreement from AMAG Pharmaceuticals. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 10, 2017.
- Revision received April 21, 2017.
- Accepted May 4, 2017.
- 2018 American College of Cardiology Foundation