Heart Failure With Preserved Ejection Fraction: Evaluation and Recognition by CMR

Study Overview
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Brief Summary
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Heart failure with preserved ejection fraction (HFpEF) is a common and growing condition with a poor prognosis but the pathophysiology and management are still being investigated. The PREFER-CMR project aims to evaluate and validate the application of novel 4D cardiac magnetic resonance flow dynamic methods to measure left ventricular pressures and validate these measurements with direct pressure measurement by coronary angiography. This is a prospective observational study of patients with HFpEF undergoing clinical evaluation with coronary angiography who will also undergo contemporaneous cardiac MRI. The primary outcome will be the level of agreement between the two methods using angiography as the reference method.

Detailed Description
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Heart failure with preserved ejection fraction (HFpEF) is prevalent, increasing in incidence and has a poor prognosis. Accurate left ventricular (LV) haemodynamic assessment is needed to diagnose and manage patients with HFpEF. The reference method for assessment is an invasive study using catheters to measure intra-ventricular pressure but this is rarely done due to its invasive nature, high procedural costs and lack of expertise, despite the fact that haemodynamic guided therapy is associated with reduced re-hospitalisation and mortality. Non-invasive methods of LV haemodynamic assessment are inaccurate. The Investigators have developed an accurate four-dimensional flow cardiac magnetic resonance (4D flow CMR) protocol which is non-invasive and addresses the issues with existing practices to evaluate HFpEF. This observational-analytical study aims to assess the utility of a non-invasive 4D flow CMR protocol for haemodynamic assessment of HFpEF, to generate clinical data to support future clinical trials, clinical translation and patient benefit. This research study will involve generating a precise haemodynamic model using invasive and non-invasive data of prospectively recruited patients. This model will be also optimised in clinical patients with arrhythmias. Also, observational data will be collected to test the model's prognostic value.

Official Title
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PReserved Ejection Fraction Evaluation and Recognition by Cardiac Magnetic Resonance

Conditions
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Heart Diseases, Heart Failure With Preserved Ejection Fraction

Intervention / Treatment
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* Diagnostic Test: Multi Parametric Cardiac Magnetic Resonance


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults: age≥18 years. Typical HF symptoms (NYHA stage>I) within the last six months. Raised NTproBNP (>400 pg/ml) EF>50 % with the absence of structural heart disease on TTE (except left ventricular hypertrophy or left atrial enlargement). Exclusion Criteria: Patients unable/unwilling to provide informed consent. Bodyweight>120 kg or inability to lie flat/still. Contraindication for invasive workup (allergy to contrast, severe renal insufficiency with estimated glomerular filtration rate (eGRF)<30 ml/min). Contraindications for a contrast-enhanced CMR study (allergy to contrast, incompatible devices or implants, severe claustrophobia). Previous medical history of EF <50% Pregnancy The extended observational arm of the study will have wider eligibility criteria - Patients undergoing cardiac MRI for clinical indications irrespective of EF

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| HFpEF group<br>Suspected HFpEF group: 80 patients will be recruited with history of dyspnoea, LV ejection fraction ≥ 50%, raised NTproBNP | Diagnostic Test: Multi Parametric Cardiac Magnetic Resonance<br>* Research based Cardiac MRI evaluation to determine cardiovascular haemodynamics<br>|
| Control group<br>20 patients with suspected CAD but with no dyspnoea and normal echocardiogram. | Diagnostic Test: Multi Parametric Cardiac Magnetic Resonance<br>* Research based Cardiac MRI evaluation to determine cardiovascular haemodynamics<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Left ventricular pressure measured by invasive angiography (reference method) and modelled by cardiovascular magnetic resonance imaging | Agreement of invasively measured left ventricular pressure in millimeters of mercury (mmHg) by invasive angiography to non-invasively modelled left ventricular pressure by cardiac magnetic resonance imaging. The agreement will be tested by Bland-Altman plots.. | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prognostic relevance of left ventricular pressures measured by cardiac MRI | Is cardiovascular magnetic resonance modelled left ventricular pressure in millimeters of mercury (mmHg) associated with MACE events including re-hospitalization, stroke, myocardial infarction and death. Association between pressure measurements and MACE will be tested by Cox proportional hazards regression and Kaplan-Meier survival analysis. | Ten years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Heart failure, hemodynamics, magnetic resonance imaging