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

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

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.

Graphical abstract

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Abbreviations

AUC:

Area under the curve

CAD:

Coronary artery disease

DM:

Diabetes mellitus

FT:

Feature tracking

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

GRS:

Global radial strain

HFpEF:

Heart failure with preserved ejection fraction

HR:

Hazard ratios

LVEF:

Left ventricular ejection fraction

LVMi:

Left ventricular end-diastole mass index

NT-proBNP:

N-terminal pro–brain natriuretic peptide

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Funding

This study was funded by the National Natural Science Foundation of China (Grants 81971588), the Construction Research Project of Key Laboratory of the Chinese Academy of Medical Sciences (2019PT310025), the Youth Key Program of High-level Hospital Clinical Research (2022-GSP-QZ-5), Beijing Natural Science Foundation (7242110) and the National Foreign Expert Talent Project (G2021194020L).

Author information

Authors and 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

    Wenjing Yang, Leyi Zhu, Jian He, Baiyan Zhuang, Jing Xu, Di Zhou, Yining Wang, Shihua Zhao & Minjie Lu

  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

    Weichun Wu

  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

    Yuhui Zhang

  4. Department of Neurology, Johns Hopkins University, Baltimore, MD, 21218, USA

    Guanshu Liu

  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

    Xiaoxin Sun

  6. Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China

    Xiaoxin Sun & Minjie Lu

  7. Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, University of Oxford, Oxford, UK

    Qiang Zhang

  8. Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA

    Arlene Sirajuddin

  9. Private Consultant, Kensington, MD, 20895, USA

    Andrew E. Arai

Authors
  1. Wenjing Yang
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  2. Leyi Zhu
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  3. Jian He
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  4. Weichun Wu
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  5. Yuhui Zhang
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  6. Baiyan Zhuang
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  7. Jing Xu
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  9. Yining Wang
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  10. Guanshu Liu
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  11. Xiaoxin Sun
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  12. Qiang Zhang
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  13. Arlene Sirajuddin
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  14. Andrew E. Arai
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  15. Shihua Zhao
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  16. Minjie Lu
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Corresponding author

Correspondence to Minjie Lu.

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Guarantor

The scientific guarantor of this publication is Minjie Lu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Only if the study is on human subjects:

Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

No study subjects or cohorts have been previously reported.

Methodology

• retrospective

• prognostic study

• performed at one institution

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Wenjing Yang and Leyi Zhu are the co-first author of this work.

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Yang, W., Zhu, L., He, J. et al. Long-term outcomes prediction in diabetic heart failure with preserved ejection fraction by cardiac MRI. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10658-y

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