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P21 Cardiac metabolism in patients with heart failure with mid-range ejection fraction
  1. MJ Hundertmark,
  2. CT Rodgers,
  3. O Rider,
  4. S Neubauer,
  5. M Mahmod
  1. Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, UK


Rationale Disturbance in cardiac energy metabolism is a key feature of heart failure (HF). It is unknown whether HF with mid-range left ventricular (LV) ejection fraction (HFmrEF), defined by LVEF 40%–49%, represents a separate clinical entity and whether there are distinct cardio-metabolic changes compared with HF patients with more severely reduced EF (HFrEF – LVEF <40%). We sought to investigate this by assessing myocardial energetics (phosphocreatine-to-adenosine triphosphate – PCr/ATP) and myocardial triglyceride (MTG) content in both HFmrEF and HFrEF.

Methods 53 subjects (13 HFmrEF, 13 HFrEF and 25 age, sex and BMI-matched controls) underwent cardiovascular magnetic (MR) resonance at 3 Tesla (3T) to assess left ventricular (LV) volumes and function, 31P-MR spectroscopy (MRS) to measure myocardial PCr/ATP, and 1H-MRS to measure MTG content.

Results There were no significant differences in PCr/ATP ratios between the two HF groups (HFmrEF 1.69±0.39 vs HFrEF 1.64±0.41 HFrEF, p<0.05), and both were significantly lower than controls (1.96±0.27, p<0.05). Similarly, MTG was not significantly different between HFmrEF (0.61%±0.39%) and HFrEF (0.71%±0.49%), both significantly higher than in controls (0.42%±0.16%, p<0.05). Interestingly, similar levels of PCr/ATP and MTG changes were observed in both HF groups despite significant differences in LV volumes (HFmrEF 192±45 vs HFrEF 270±92, p<0.001) and EF (HFmrEF 46±3 vs HFrEF 31±6, p<0.001).

Conclusion Our results indicate no differences in energetic and lipid derangement between HFmrEF and HFrEF. This emphasises the need for a new phenotyping model for HF patients based on factors other than LVEF.

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