Lung water density is increased in patients at risk of heart failure and is largely independent of conventional cardiovascular magnetic resonance measures

Nithin R Iyer; Jennifer A Bryant; Thu-Thao Le; Justin G Grenier; Richard B Thompson; Calvin W L Chin; Martin Ugander

doi:10.1093/ehjimp/qyae089

Lung water density is increased in patients at risk of heart failure and is largely independent of conventional cardiovascular magnetic resonance measures

Eur Heart J Imaging Methods Pract. 2024 Aug 27;2(3):qyae089. doi: 10.1093/ehjimp/qyae089. eCollection 2024 Jul.

Authors

Nithin R Iyer^{1

2}, Jennifer A Bryant², Thu-Thao Le^{2

3}, Justin G Grenier⁴, Richard B Thompson⁴, Calvin W L Chin^{2

3}, Martin Ugander^{1

5}

Affiliations

¹ Kolling Institute, Royal North Shore Hospital, The University of Sydney, St Leonards, NSW, Australia.
² Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore.
³ Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore, Singapore.
⁴ Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada.
⁵ Department of Clinical Physiology, NKS C8:27, Karolinska University Hospital, Karolinska Institutet, SE-17176 Stockholm, Sweden.

Abstract

Aims: Non-invasive methods to quantify pulmonary congestion are lacking in clinical practice. Cardiovascular magnetic resonance (CMR) lung water density (LWD) mapping is accurate and reproducible and has prognostic value. However, it is not known whether LWD is associated with routinely acquired CMR parameters.

Methods and results: This was an observational cohort including healthy controls and patients at risk of heart failure. LWD was measured using CMR with a free-breathing short echo time 3D Cartesian gradient-echo sequence with a respiratory navigator at 1.5 T. Associations were assessed between LWD, lung water volume and cardiac volumes, left ventricular (LV) mass and function, myocardial native T1, and extracellular volume fraction. In patients at risk for heart failure (n = 155), LWD was greater than in healthy controls (n = 15) (30.4 ± 5.0 vs. 27.2 ± 4.3%, P = 0.02). Using receiver operating characteristic analysis, the optimal cut-off for LWD was 27.6% to detect at-risk patients (sensitivity 72%, specificity 73%, positive likelihood ratio 2.7, and inverse negative likelihood ratio 2.6). LWD was univariably associated with body mass index (BMI), hypertension, right atrial area, and LV mass. In multivariable linear regression, only BMI remained associated with LWD (R ² = 0.32, P < 0.001).

Conclusion: LWD is increased in patients at risk for heart failure compared with controls and is only weakly explained by conventional CMR measures. LWD provides diagnostic information that is largely independent of conventional CMR measures.