Long-term outcomes prediction in diabetic heart failure with preserved ejection fraction by cardiac MRI

Wenjing Yang; Leyi Zhu; Jian He; Weichun Wu; Yuhui Zhang; Baiyan Zhuang; Jing Xu; Di Zhou; Yining Wang; Guanshu Liu; Xiaoxin Sun; Qiang Zhang; Arlene Sirajuddin; Andrew E Arai; Shihua Zhao; Minjie Lu

doi:10.1007/s00330-024-10658-y

Long-term outcomes prediction in diabetic heart failure with preserved ejection fraction by cardiac MRI

Eur Radiol. 2024 Feb 29. doi: 10.1007/s00330-024-10658-y. Online ahead of print.

Authors

Wenjing Yang¹, Leyi Zhu¹, Jian He¹, Weichun Wu², Yuhui Zhang³, Baiyan Zhuang¹, Jing Xu¹, Di Zhou¹, Yining Wang¹, Guanshu Liu⁴, Xiaoxin Sun^{5

6}, Qiang Zhang⁷, Arlene Sirajuddin⁸, Andrew E Arai⁹, Shihua Zhao¹, Minjie Lu^{10

11}

Affiliations

¹ Departments of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
² Departments of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
³ Department of Heart Failure Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
⁴ Department of Neurology, Johns Hopkins University, Baltimore, MD, 21218, USA.
⁵ Departments of Nuclear Medicine, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
⁶ Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China.
⁷ Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
⁸ Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
⁹ Private Consultant, Kensington, MD, 20895, USA.
¹⁰ Departments of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China. coolkan@163.com.
¹¹ Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China. coolkan@163.com.

PMID: 38421414
DOI: 10.1007/s00330-024-10658-y

Abstract

Objectives: We aimed to explore imaging features including tissue characterization and myocardial deformation in diabetic heart failure with preserved ejection fraction (HFpEF) patients by magnetic resonance imaging (MRI) and investigate its prognostic value for adverse outcomes.

Materials and methods: Patients with HFpEF who underwent cardiac MRI between January 2010 and December 2016 were enrolled. Feature-tracking (FT) analysis and myocardial fibrosis were assessed by cardiac MRI. Cox proportional regression analysis was performed to determine the association between MRI variables and primary outcomes. Primary outcomes were all-cause death or heart failure hospitalization during the follow-up period.

Results: Of the 335 enrolled patients with HFpEF, 191 had diabetes mellitus (DM) (mean age: 58.7 years ± 10.8; 137 men). During a median follow-up of 10.2 years, 91 diabetic HFpEF and 56 non-diabetic HFpEF patients experienced primary outcomes. DM was a significant predictor of worse prognosis in HFpEF. In diabetic HFpEF, the addition of conventional imaging variables (left ventricular ejection fraction, left atrial volume index, extent of late gadolinium enhancement (LGE)) and global longitudinal strain (GLS) resulted in a significant increase in the area under the receiver operating characteristic curve (from 0.693 to 0.760, p < 0.05). After adjustment for multiple clinical and imaging variables, each 1% worsening in GLS was associated with a 9.8% increased risk of adverse events (p = 0.004).

Conclusions: Diabetic HFpEF is characterized by more severely impaired strains and myocardial fibrosis, which is identified as a high-risk HFpEF phenotype. In diabetic HFpEF, comprehensive cardiac MRI provides incremental value in predicting prognosis. Particularly, MRI-FT measurement of GLS is an independent predictor of adverse outcome in diabetic HFpEF.

Clinical relevance statement: Our findings suggested that MRI-derived variables, especially global longitudinal strain, played a crucial role in risk stratification and predicting worse prognosis in diabetic heart failure with preserved ejection fraction, which could assist in identifying high-risk patients and guiding therapeutic decision-making.

Key points: • Limited data are available on the cardiac MRI features of diabetic heart failure with preserved ejection fraction, including myocardial deformation and tissue characterization, as well as their incremental prognostic value. • Diabetic heart failure with preserved ejection fraction patients was characterized by more impaired strains and myocardial fibrosis. Comprehensive MRI, including tissue characterization and global longitudinal strain, provided incremental value for risk prediction. • MRI served as a valuable tool for identifying high-risk patients and guiding clinical management in diabetic heart failure with preserved ejection fraction.

Keywords: Cardiac magnetic resonance imaging; Diabetes mellitus; Global longitudinal strain; Heart failure with preserved ejection fraction.