Characterization of the electrical and extracellular matrix remodeling in patients with HF: comparison between HEpEF and HErEF

Resumo

This study aimed to assess and compare myocardical electrical and extracellular matrix remodeling in patients with heart failure (HF) with preserved ejection fraction (HFpEF) and with heart failure with reduced ejection fraction (HFrEF) using a contemporary multimodality approach. We recruited 47 individuals presenting HF (22 females, 25 males), NYHA classes II-III, stratified according to LVEF in HFpEF (n=23) and HFrEF (n=24). They underwent cardiac MRI (CMRI) including T1-mapping, echocardiography for global longitudinal strain (GLS), cardiopulmonary exercise test (CPET), cardiac sympathetic imaging with mIBG and biomarkers. Results show native-T1 and extracellular volume fraction (ECV) were not different between groups. The mIBG derived heart-to-mediastinum ratio (HMR) were reduced in both groups. Considering the entire cohort, as well as the HFrEF subgroup separately, ECV was inversely associated to HMR and to adjusted VO2 max, and positively associated to NT-proBNP, US-Troponin and to GLS. Considering the HFpEF subgroup separately, only ECV and GLS association remained significant. The study highlights that similar extracellular matrix remodeling, assessed by ECV, between both subgroups confirms diffuse fibrosis as part of the HFpEF cardiac phenotype, which may partially explain its unfavorable prognosis and limited response to anti-remodeling therapies.