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Cardiac reserve index as a novel method for diagnosing heart failure: a cardiac magnetic resonance study in heart failure patients, healthy volunteers and athletes

Introduction

An early sign of HF is a decreased cardiac reserve or inability to increase cardiac output to meet the metabolic requirements during exercise. Under normal circumstances maximal cardiac output is closely related to VO2max which has recently been shown to be closely related to THV.

Purpose

The aim of this study was to a novel cardiac reserve index (VO2max/THV) and test the hypothesis this index can be used to distinguish patients with HF from healthy volunteers and endurance athletes.

Methods

Twenty-six patients with clinical HF of different etiologies were retrospectively included and 131 control subjects (60 healthy volunteers and 71 athletes) were prospectively enrolled. Peak oxygen uptake was determined by maximal exercise test and THV was determined by cardiac magnetic resonance. A novel cardiac reserve index, calculated as VO2max/THV, was then derived and tested.

Results

Peak oxygen uptake was strongly correlated to THV (r2 = 0.74, P < 0.001) in the control subjects, but not for the patients (r2 = 0.0006, p = 0.90). The cardiac reserve index differed significantly between control subjects and patients (Figure 1A), even in patients with normal ejection fraction and after normalizing for hemoglobin levels (P < 0.001, Figure 1B). In both figures, the box represents the median, the 25th and the 75th percentile and the whiskers represent minimum and maximum values. In a multivariate analysis the cardiac reserve index was the only independent predictor of presence of HF (P < 0.001).

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Figure 1

Conclusion

The cardiac reserve index VO2max/THV can be used to distinguish patients with HF from healthy volunteers and athletes, even in patients with preserved systolic left ventricular function and after normalizing for hemoglobin levels.

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Correspondence to Henrik Engblom.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Engblom, H., Steding, K., Carlsson, M. et al. Cardiac reserve index as a novel method for diagnosing heart failure: a cardiac magnetic resonance study in heart failure patients, healthy volunteers and athletes. J Cardiovasc Magn Reson 12, P193 (2010). https://doi.org/10.1186/1532-429X-12-S1-P193

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Keywords

  • Heart Failure
  • Healthy Volunteer
  • Control Subject
  • Cardiac Output
  • Hemoglobin Level