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Background  Pulmonary edema is a cardinal feature of heart failure but no quantitative tests are available in clinical practice. The goals of this study were to develop a simple cardiovascular magnetic resonance (CMR) approach for lung water quantification, to correlate CMR derived lung water with intra-cardiac pressures and to determine its prognostic significance.    Methods  Lung water density (LWD, %) was measured using a widely available single-shot fast spin-echo acquisition in two study cohorts.  Validation Cohort : LWD was compared to left ventricular end-diastolic pressure or pulmonary capillary wedge pressure in 19 patients with heart failure undergoing cardiac catheterization.  Prospective Cohort:  LWD was measured in 256 subjects, including 121 with heart failure, 82 at-risk for heart failure and 53 healthy controls. Clinical outcomes were evaluated up to 1 year.    Results  Within the validation cohort, CMR LWD correlated to invasively measured left-sided filling pressures (R = 0.8,  p  < 0.05). In the prospective cohort, mean LWD was 16.6 ± 2.1% in controls, 17.9 ± 3.0% in patients at-risk and 19.3 ± 5.4% in patients with heart failure,  p  < 0.001. In patients with or at-risk for heart failure, LWD >  20.8% (mean + 2 standard deviations of healthy controls) was an independent predictor of death, hospitalization or emergency department visit within 1 year, hazard ratio 2.4 (1.1–5.1,  p  = 0.03).    Conclusions  In patients with heart failure, increased CMR-derived lung water is associated with increased intra-cardiac filling pressures, and predicts 1 year outcomes. LWD could be incorporated in standard CMR scans.    Electronic supplementary material  The online version of this article (10.1186/s12968-019-0567-y) contains supplementary material, which is available to authorized users.

Quantification of lung water in heart failure using cardiovascular magnetic resonance imaging