Jørgen Frøkiær

Myocardial efficiency in patients with different aetiologies and stages of heart failure

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DOI

  • Kristoffer Berg Hansen
  • Jens Sörensen, Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark; and., Hospital Pharmacy, Aarhus University Hospital, Aarhus, Department of Medical and Surgical Sciences, Uppsala University and Uppsala Clinical Research Center, Uppsala University, Sweden.
  • ,
  • Nils Henrik Hansson, Hospital Pharmacy, Aarhus University Hospital, Aarhus
  • ,
  • Roni Nielsen, Hospital Pharmacy, Aarhus University Hospital, Aarhus
  • ,
  • Anders Hostrup Larsen, Hospital Pharmacy, Aarhus University Hospital, Aarhus
  • ,
  • Jørgen Frøkiær
  • Lars Poulsen Tolbod
  • Lars Christian Gormsen
  • Hendrik Johannes Harms, Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark; and., Hospital Pharmacy, Aarhus University Hospital, Aarhus
  • ,
  • Henrik Wiggers

AIMS: Myocardial external efficiency (MEE) is the ratio of cardiac work in relation with energy expenditure. We studied MEE in patients with different aetiologies and stages of heart failure (HF) to discover the role and causes of deranged MEE. In addition, we explored the impact of patient characteristics such as sex, body mass index (BMI), and age on myocardial energetics.

METHODS AND RESULTS: Cardiac energetic profiles were assessed with 11C-acetate positron emission tomography (PET) and left ventricular ejection fraction (LVEF) was acquired with echocardiography. MEE was studied in 121 participants: healthy controls (n = 20); HF patients with reduced (HFrEF; n = 25) and mildly reduced (HFmrEF; n = 23) LVEF; and patients with asymptomatic (AS-asymp; n = 38) and symptomatic (AS-symp; n = 15) aortic stenosis (AS). Reduced MEE coincided with symptoms of HF irrespective of aetiology and declined in tandem with deteriorating LVEF. Patients with AS-symp and HFmrEF had reduced MEE as compared with controls (22.2 ± 4.9%, P = 0.041 and 20.0 ± 4.2%, P < 0.001 vs. 26.1 ± 5.8% in controls) and a further decline was observed in patients with HFrEF (14.7 ± 6.3%, P < 0.001). Disproportionate left ventricular hypertrophy was a major cause of reduced MEE. Female sex (P < 0.001), a lower BMI (P = 0.001), and advanced age (P = 0.03) were associated with a lower MEE.

CONCLUSION: MEE was reduced in patients with HFrEF, HFmrEF, and HF due to pressure overload and MEE may therefore constitute a treatment target in HF. Patients with LVH, advanced age, female sex, and low BMI had more pronounced reduction in MEE and personalized treatment within these patient subgroups could be relevant.

Original languageEnglish
JournalEuropean Heart Journal Cardiovascular Imaging
ISSN1525-2167
DOIs
Publication statusE-pub ahead of print - 9 Nov 2021

Bibliographical note

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.

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