Schuster, Andreas

[["dc.bibliographiccitation.journal","Circulation"],["dc.contributor.author","Backhaus, Sören J"],["dc.contributor.author","Lange, Torben"],["dc.contributor.author","George, Elisabeth F"],["dc.contributor.author","Hellenkamp, Kristian"],["dc.contributor.author","Gertz, Roman J"],["dc.contributor.author","Billing, Marcus"],["dc.contributor.author","Wachter, Rolf"],["dc.contributor.author","Steinmetz, Michael"],["dc.contributor.author","Kutty, Shelby"],["dc.contributor.author","Raaz, Uwe"],["dc.contributor.author","Lotz, Joachim"],["dc.contributor.author","Friede, Tim"],["dc.contributor.author","Uecker, Martin"],["dc.contributor.author","Hasenfuß, Gerd P."],["dc.contributor.author","Seidler, Tim"],["dc.contributor.author","Schuster, Andreas"],["dc.date.accessioned","2021-03-08T07:13:50Z"],["dc.date.available","2021-03-08T07:13:50Z"],["dc.date.issued","2021-01-21"],["dc.description.abstract","Background: Right heart catheterisation (RHC) using exercise-stress is the reference standard for the diagnosis of heart failure with preserved ejection fraction (HFpEF) but carries the risk of the invasive procedure. We hypothesized that real-time cardiovascular magnetic resonance (RT-CMR) exercise imaging with pathophysiologic data at excellent temporal and spatial resolution may represent a contemporary non-invasive alternative for diagnosing HFpEF. Methods: The HFpEF stress trial (DZHK-17, NCT03260621) prospectively recruited 75 patients with echocardiographic signs of diastolic dysfunction and dyspnea on exertion (E/e'>8, New York Heart Association (NYHA) class ≥II) to undergo echocardiography, RHC and RT-CMR at rest and during exercise-stress. HFpEF was defined according to pulmonary capillary wedge pressure (PCWP ≥15mmHg at rest or ≥25mmHg during exercise stress). RT-CMR functional assessments included time-volume curves for total and early (1/3) diastolic left ventricular (LV) filling, left atrial (LA) emptying and LV/LA long axis strain (LAS). Results: HFpEF patients (n=34, median PCWP rest 13mmHg, stress 27mmHg) had higher E/e' (12.5 vs. 9.15), NT-proBNP (255 vs. 75ng/l) and LA volume index (43.8 vs. 36.2ml/m2) compared to non-cardiac dyspnea patients (n=34, rest 8mmHg, stress 18mmHg, p≤0.001 for all). Seven patients were excluded due to the presence of non HFpEF cardiac disease causing dyspnea on imaging. There were no differences in RT-CMR LV total and early diastolic filling at rest and during exercise-stress (p≥0.164) between HFpEF and non-cardiac dyspnea. RT-CMR revealed significantly impaired LA total and early (p<0.001) diastolic emptying in HFpEF during exercise-stress. RT-CMR exercise-stress LA LAS was independently associated with HFpEF (adjusted odds ratio 0.657, 95% confidence interval [0.516; 0.838], p=0.001) after adjustment for clinical and imaging parameters and emerged as the best predictor for HFpEF (area under the curve rest 0.82 vs. exercise-stress 0.93, p=0.029). Conclusions: RT-CMR allows highly accurate identification of HFpEF during physiological exercise and qualifies as a suitable non-invasive diagnostic alternative. These results will need to be confirmed in multi-centre prospective research studies to establish widespread routine clinical use. Clinical Trial Registration: URL: https://www.clinicaltrials.gov Unique Identifier: NCT03260621."],["dc.identifier.doi","10.1161/CIRCULATIONAHA.120.051542"],["dc.identifier.pmid","33472397"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/80476"],["dc.identifier.url","https://mbexc.uni-goettingen.de/literature/publications/302"],["dc.language.iso","en"],["dc.relation","EXC 2067: Multiscale Bioimaging"],["dc.relation.issn","0009-7322"],["dc.relation.issn","1524-4539"],["dc.relation.workinggroup","RG Hasenfuß"],["dc.relation.workinggroup","RG Uecker"],["dc.title","Exercise-Stress Real-time Cardiac Magnetic Resonance Imaging for Non-Invasive Characterisation of Heart Failure with Preserved Ejection Fraction: The HFpEF Stress Trial"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.subtype","original_ja"],["dspace.entity.type","Publication"]]