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Exercise-Induced Alterations in Lung Water Density in Heart Failure Using Single-Breath-Hold 3D Ultrashort Echo Time
Hang Chen1, Manuel A Morales1, Alexander Schulz1
1Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
Journal of Magnetic Resonance Imaging : JMRI
|June 18, 2026
Summary
3D ultrashort echo time (UTE) MRI reproducibly measures lung water density (LWD) changes after exercise. Heart failure with preserved ejection fraction (HFpEF) patients showed greater LWD alterations, indicating its utility in assessing pulmonary congestion.
Area of Science:
- Cardiovascular Imaging
- Pulmonary Medicine
- Medical Physics
Background:
- Pulmonary congestion evaluation post-exercise in heart failure (HF) can reveal exercise intolerance and dyspnea insights.
- Assessing exercise-induced pulmonary changes is crucial for understanding HF pathophysiology.
Purpose of the Study:
- To investigate the reproducibility of lung water density (LWD) measurements using 3D ultrashort echo time (UTE) MRI.
- To evaluate exercise-induced alterations in LWD in heart failure patients and healthy controls.
Main Methods:
- Prospective study utilizing 3-Tesla (3T) MRI with a 3D stack-of-spirals UTE Volumetric Interpolated Breath-hold Examination (VIBE) sequence.
- Sixty-nine HF patients (across HFpEF, HFmrEF, HFimpEF, HFrEF categories) and 34 healthy subjects underwent MRI at rest and post-exercise.
- Reproducibility assessed via scan/rescan studies; LWD quantified using normalized pixel intensity; statistical analyses included Shapiro-Wilk, ANOVA, t-tests, and Bland-Altman analysis.
Main Results:
- In healthy controls, LWD significantly decreased post-exercise (-1.25% absolute change).
- Heart failure with preserved ejection fraction (HFpEF) patients exhibited a significantly greater absolute LWD increase (0.47%) compared to controls.
- No significant differences in LWD changes were observed in other HF subgroups compared to controls; lung volume changes did not differ across groups.
Conclusions:
- Single-breath-hold 3D UTE MRI offers reproducible LWD measurements and detects exercise-induced alterations.
- This MRI technique effectively captures pulmonary fluid changes post-exercise.
- The study identified a distinct, greater LWD response to exercise in HFpEF patients.
