February 7, 2024Open Access

Distinguishing heart failure subtypes: the diagnostic power of different cardiac magnetic resonance imaging parameters

Structured PICO

Does cardiac magnetic resonance imaging (native T1, ECV, myocardial strain) improve the diagnosis of HFpEF compared to healthy controls?

Population

76 participants including 30 with heart failure with mid-ranged and reduced ejection fraction (HFm+rEF), 29 with heart failure with preserved ejection fraction (HFpEF), and 17 healthy controls. Exclusions included coronary artery disease, congenital heart disease, severe respiratory diseases, and eGFR <30 ml/(min·1.73 m2).

Intervention

Cardiac magnetic resonance imaging (CMR) evaluating left ventricular function, myocardial strain (GLS, GCS, GRS), native T1, enhanced T1, and extracellular volume (ECV).

Comparator

Healthy controls and patients with HFm+rEF.

Outcome

Diagnostic performance (AUC-ROC) of CMR parameters in differentiating HFpEF from normal controls.surrogate

Native T1 mapping and myocardial strain parameters from CMR provide high diagnostic accuracy for differentiating HFpEF from healthy controls, offering a non-invasive tool for early detection.

Abstract

Objectives: The aim of this retrospective study was to explore the diagnostic potential of various cardiac parameters in differentiating between heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-ranged and reduced ejection fraction (HFm + rEF), and to discern their relationship with normal cardiac function. Methods: This research encompassed a comparative analysis of heart failure subtypes based on multiple indicators. Participants were categorized into HFm + rEF, HFpEF, and control groups. For each participant, we investigated indicators of left ventricular function (LVEDVi, LVESVi, and LVEF) and myocardial strain parameters (GLS, GCS, GRS). Additionally, quantitative tissue evaluation parameters including native T1, enhanced T1, and extracellular volume (ECV) were examined.For comprehensive diagnostic performance analysis, receiver operating characteristic (ROC) curve evaluations for each parameters were conducted. Results: HFm + rEF patients exhibited elevated LVEDVi and LVESVi and decreased LVEF compared to both HFpEF and control groups. Myocardial strain revealed significant reductions in GLS, GCS, and GRS for HFm + rEF patients compared to the other groups. HFpEF patients showed strain reductions relative to the control group. In cardiac magnetic resonance imaging (CMR) evaluations, HFm + rEF patients demonstrated heightened native T1 times and ECV fractions. Native T1 was particularly effective in distinguishing HFpEF from healthy subjects. Conclusion: Native T1, ECV, and myocardial strain parameters have substantial diagnostic value in identifying HFpEF. Among them, native T1 displayed superior diagnostic efficiency relative to ECV, offering critical insights into early-stage HFpEF. These findings can play a pivotal role in refining clinical management and treatment strategies for heart failure patients.

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