31 Aortic flow abnormalities can diagnose heart failure with preserved ejection fraction
Abstracts, pp. A25–A27
Abstract
Introduction There is growing interest in identifying cardiovascular magnetic resonance (CMR) signatures in ageing due to their relevance to cardiovascular health.1 It also remains uncertain whether patients with heart failure with preserved ejection fraction (HFpEF) have disruptions in their aortic flow. This study aimed to explore sophisticated indicators of aortic flow disturbances in ageing and in HFpEF. Materials and Methods This study used two-dimensional phase-contrast CMR data at an orthogonal plane just above the sino-tubular junction. We recruited 10 young healthy controls (HCs), 10 old HCs and 23 patients with HFpEF. We analysed average systolic aortic flow displacement (FDsavg), systolic flow reversal ratio (sFRR) and pulse wave velocity (PWV). In a sub-group analysis, we compared old HCs versus age-gender-matched HFpEF (N=10). Results Differences were significant in mean age (P<0.001) among young HCs (22.9±3.5 years), old HCs (60.5±10.2 years) and HFpEF patients (73.7±9.7 years). FDsavg, sFRR and PWV varied significantly (P<0.001) in young HCs (8±4%, 2±2%, 4±2m/s), old HCs (16±5%, 7±6%, 11±8m/s), and HFpEF patients (23±10%, 11±10%, 8±3). No significant PWV differences existed between old HCs and HFpEF. (table 1, figure 1 and figure 2) HFpEF had significantly higher FDsavgversus old HCs (23±10% vs 16±5%, P<0.001). A FDsavg > 17.7% achieved 74% sensitivity, 70% specificity for differentiating them. sFRR was notably higher in HFpEF (11±10% vs 7±6%, P<0.001). A sFRR > 7.3% yielded 78% sensitivity, 70% specificity in differentiating these groups. (figure 2) In sub-group analysis, FDsavg remained distinctly elevated in HFpEF (22.4±9.7% vs 16±4.9%, P=0.029). FDsavg of >16% showed 100% sensitivity and 70% specificity (P=0.01). Similarly, sFRR remained significantly higher in HFpEF (11.3±9.5% vs 6.6±6.4%, P=0.007). A sFRR of >7.2% showed 100% sensitivity and 60% specificity (P<0.001). (figure 3) Discussion This study is one of the first to show a rise in sFRR and FDsavg in both ageing and HFpEF with distinct differences between the two groups even when matched for age and gender. CMR-derived FDsavg and sFRR can assist in early detection and sub phenotyping of HFpEF. Our recent work2 demonstrated that these aortic flow abnormalities, particularly, FDsavg, can led to reduced exercise capacity and identify high risk individuals. Conclusion Aortic flow haemodynamics (FDsavg and sFRR) are significantly affected in ageing and HFpEF patients. Studies with larger and diverse cohort are required to draw definitive conclusions. Acknowledgements References Shah M, et al. Environmental and genetic predictors of human cardiovascular ageing. Nature Communications 2023;14(1). Zhao X, et al. Aortic flow is associated with aging and exercise capacity. European Heart Journal Open 2023;3(4).
Authors 19
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Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust
Affiliation as printed
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust
Affiliation as printed
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust
Affiliation as printed
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust
Affiliation as printed
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust
Affiliation as printed
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust
Affiliation as printed
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust
Affiliation as printed
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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National Heart Centre Singapore
Affiliation as printed
National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
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National University of Singapore · Duke-NUS Medical School · National Heart Centre Singapore
Affiliation as printed
Cardiovascular Sciences Academic Clinical Program and Cardiovascular Metabolic Disorder Program, Duke National University of Singapore Medical School, Singapore
Department of Biomedical Engineering, National University of Singapore
National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
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St Bartholomew's Hospital · Queen Mary University of London · Barts Health NHS Trust · William Harvey Research Institute
Affiliation as printed
Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust
Affiliation as printed
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust
Affiliation as printed
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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Affiliation as printed
Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Affiliation as printed
Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust
Affiliation as printed
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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Manchester Academic Health Science Centre · University of Manchester
Affiliation as printed
Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Leiden University Medical Center
Affiliation as printed
Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
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St Bartholomew's Hospital · Queen Mary University of London · Barts Health NHS Trust · William Harvey Research Institute
Affiliation as printed
Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust
Affiliation as printed
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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