title: Global myocardial oedema in advanced decompensated heart failure.
abstract: OBJECTIVE
  To use cardiac magnetic resonance (CMR) imaging with quantitative T2 mapping as surrogate for myocardial water content in patients with advanced decompensated heart failure (ADHF), compare these values with T2-values observed in chronic heart failure, and evaluate the change with decongestive therapy.
  
  
  RESULTS
  Volumetric CMR measurements and quantitative T2 mapping were performed in 18 consecutive ADHF patients with clinical signs of volume overload. Eleven patients with stable heart failure were used as controls. Vasodilator therapy and diuretics were administered to achieve a pulmonary arterial wedge pressure (PAWP) of <18 mmHg and central venous pressure (CVP) of <12 mmHg, after which CMR was repeated. ADHF patients (62 ± 12 years; 89% male; left ventricular ejection fraction 23 ± 8%) presented with low cardiac index (2.08 ± 0.59 L/min/m2), high PAWP (25 ± 7 mmHg), and high CVP (14 ± 5 mmHg). After decongestion, the patients had a significant increase in cardiac index (+0.41 ± 0.53 L/min/m2; P = 0.005) and decreases in both PAWP (-9 ± 6 mmHg; P < 0.001) and CVP (-6 ± 5 mmHg; P < 0.001). At baseline, global left ventricular T2-values were higher in ADHF patients compared with controls (59.5 ± 4.6 vs. 54.7 ± 2.2 ms, respectively; P = 0.001). After decongestion, T2-values fell significantly to 55.9 ± 5.1 ms (P = 0.001), comparable with controls (P = 0.580). In contrast, psoas muscle T2-values were similar at baseline (38.6 ± 4.4 ms) vs. after decongestion (37.8 ± 4.8 ms; P = 0.397). Each 1 ms decrease in global left ventricular T2-value during decongestion was associated with a 1.14 ± 0.40 mmHg decrease in PAWP (P = 0.013), after correction for age and gender.
  
  
  CONCLUSIONS
  Patients presenting with ADHF and volume overload have increased global left ventricular-but not psoas muscle-T2-values, which decrease with successful decongestion. Relief of myocardial oedema correlates with haemodynamic unloading.
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk 3600, Belgium.|Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
authors.forename: Frederik H
authors.initials: FH
authors.lastname: Verbrugge
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk 3600, Belgium.|Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
authors.forename: Philippe B
authors.initials: PB
authors.lastname: Bertrand
authors.affiliation: Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Endry
authors.initials: E
authors.lastname: Willems
authors.affiliation: Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Ellen
authors.initials: E
authors.lastname: Gielen
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk 3600, Belgium.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Mullens
authors.affiliation: Siemens Healthcare, Chicago, IL, USA.
authors.forename: Shivraman
authors.initials: S
authors.lastname: Giri
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: W H Wilson
authors.initials: WHW
authors.lastname: Tang
authors.affiliation: The Ohio State University, Columbus, OH, USA.
authors.forename: Subha V
authors.initials: SV
authors.lastname: Raman
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk 3600, Belgium.
authors.forename: David
authors.initials: D
authors.lastname: Verhaert
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002908:Chronic Disease; D004489:Edema, Cardiac / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D018579:Patient Selection; D011379:Prognosis; D012016:Reference Values; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D002316:Cardiotonic Agents; D014665:Vasodilator Agents
keywords: magnetic resonance imaging; myocardium; oedema; systolic heart failure