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. 2024 Aug 27;2(3):qyae089.
doi: 10.1093/ehjimp/qyae089. eCollection 2024 Jul.

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  1   2 , Jennifer A Bryant  2 , Thu-Thao Le  2   3 , Justin G Grenier  4 , Richard B Thompson  4 , Calvin W L Chin  2   3 , Martin Ugander  1   5
Affiliations

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 et al. Eur Heart J Imaging Methods Pract. .

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.

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Conflict of interest statement

Conflict of interest: M.U. is a principal investigator for an institutional research and development agreement regarding CMR imaging between Karolinska University Hospital and Siemens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Flow chart of patient inclusion.
Figure 2
Figure 2
LWD and LWV according to clinical group: LWD was higher in patients at risk of heart failure compared with healthy controls (A); LWV did not differ between healthy controls and patients at risk of heart failure (B). Whiskers were plotted using the Tukey method. Outliers are not shown for clarity.
Figure 3
Figure 3
Receiver operating characteristic curve and corresponding AUC describing the diagnostic performance of LWD to detect patients at risk of heart failure.
Figure 4
Figure 4
Scatter plots showing univariable relationships between LWD and clinical or routinely acquired CMR markers. LWD was significantly associated with BMI (B), LV mass (D), and RA area (G). The line of best fit is shown for each analysis.
Figure 5
Figure 5
Illustrative lung images. Coronal, sagittal, and transverse slices from a 3D Cartesian lung water image in (A) control subject and (C) patient at risk of heart failure. LWD (%) in the lung parenchyma following image normalization and masking for the same slice locations shown in A (B) and C (D) showing globally increased LWD in the patient.
Figure 6
Figure 6
Scatter plots showing univariable relationships between LWV and clinical or routinely acquired CMR markers. LWV was significantly associated with age (A), BSA (C), LA volume (D), LV mass (E), RV end-diastolic volume (F), GLS (G), and ECV (H). The line of best fit is shown for each analysis.
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