Assessment of cardiometabolic risk using routine cardiac magnetic resonance imaging in heart failure with preserved ejection fraction
Y Crum, T P Willems, M Lobeek, Y Van Kerkhof, S M Ng, M Rienstra, A A Voors, L M G Meems, D J Van Veldhuisen, T M GorterAbstract
Background
Obesity is a key factor in heart failure with preserved ejection fraction (HFpEF). While body mass index (BMI) defines the presence of obesity, this gross measurement is limited in estimating cardiometabolic risk for individual patients. We investigated if specific parameters related to visceral and sarcopenic-obesity measured on routine cardiac magnetic resonance (CMR) aid in the estimation of cardiometabolic risk in patients with HFpEF, and to explore if there are important sex-related differences regarding these CMR parameters.
Methods
In total, 131 consecutive patients with HFpEF from three prospective cohorts underwent routine CMR at our institution. Visceral adiposity was assessed by quantifying pericardial adipose tissue volume (i.e. the adipose tissue situated outside the pericardium) in ml indexed for height (PATi) (Figure 1A). In addition, the Trufi axial slice was used to estimate muscle mass by measuring the area of the erector spinae fascia and to assess fatty muscle infiltration within the erector spinae, at the level of the carina (Figure 1B). All patients were followed for the combined outcome of all-cause mortality and HF hospitalization.
Results
Mean age was 73±8 years, 50% were women and mean BMI was 30±6 kg/m2. While BMI and the presence of hypertension, dyslipidemia and diabetes mellitus were comparable between men and women (all p>0.1), men had significantly higher PATi (99±34 vs.77±30 mL/m, p<0.001) and higher area of the erector spinae fascia (16.8 vs. 12.8cm2, p<0.001), but lower fatty muscle infiltration (31±15 vs. 39±15%, p=0.008), compared to women. Higher PATi was associated with higher fatty muscle infiltration (r=0.31, p=0.002). During a median follow-up of 2.0±0.3 years, both PATi and fatty muscle infiltration were associated with an increased risk for the combined outcome [hazard ratio (HR) 1.62, p=0.006; HR 1.62, p=0.043, respectively]. After adjustment for age, sex, BMI, hypertension, dyslipidemia and diabetes mellitus, only PATi remained associated with outcome [HR 1.69, p=0.022 (95% CI 1.08-2.64)], Figure 2.
Conclusion
Important sex-related differences exist in pericardial adipose tissue volume and erector spinae muscle area and fatty muscle infiltration, while conventional markers of cardiometabolic risk were comparable between men and women. These CMR parameters may improve individual cardiometabolic risk estimation in patients with HFpEF.Figure 1For image description, please refer to the figure legend and surrounding text.Figure 2For image description, please refer to the figure legend and surrounding text.