Key result
Mobile CMR screening detects subclinical pre-heart failure ~7 years earlier than standard care.
Why the study?
Screening for subclinical pre-HF may reduce symptomatic HF, but validated screening algorithms are currently lacking.
Does mobile cardiac magnetic resonance screening detect subclinical pre-heart failure earlier than standard of care in an at-risk rural population?
Cross-Sectional (n=4,509)
Yes
Does mobile cardiac magnetic resonance screening detect subclinical pre-heart failure earlier than standard of care in an at-risk rural population?
Mobile CMR screening using global longitudinal strain can identify subclinical pre-heart failure in at-risk populations significantly earlier than standard symptom-based diagnosis, offering a window for preventive interventions.
May support earlier subclinical pre-HF detection in underserved populations; hypothesis-generating and requires prospective outcome trials before practice change.
BACKGROUND: There is a growing consensus that screening for subclinical preheart failure (HF) may reduce the burden of symptomatic HF by allowing for timely preventive interventions. However, validated screening algorithms are currently lacking. The aim of this study was to evaluate a fully mobile telemedically supervised cardiac magnetic resonance, as a simple standardized, and ubiquitously applicable screening algorithm for subclinical pre-HF in rural and underresourced regions. METHODS: HERZCHECK was a cross-sectional cohort study conducted at 12 sites across rural and underresourced regions of Germany. Asymptomatic participants (40-69 years) with ≥1 cardiovascular risk factor-obesity, smoking, arterial hypertension, diabetes, hypercholesterolemia, or chronic kidney disease-were enrolled and underwent telemedically supervised contrast-free short cardiac magnetic resonance in mobile screening units. Subclinical pre-HF was diagnosed using a predefined cutoff of global longitudinal strain ≥-15%. A matched and entropy-balanced control cohort constructed from claims data was used to determine the time difference between detection of subclinical pre-HF in HERZCHECK and the first symptom-based diagnosis of HF within the standard of care. RESULTS: Between June 2021 and April 2023, 4666 participants were enrolled in the study, of which 4509 participants were included in the final analysis. The prevalence of subclinical pre-HF in the studied at-risk population was 22.7% (95% CI, 21.5%-23.9%). Global longitudinal strain-based screening identified subclinical pre-HF 6.7 years before the average onset of symptomatic HF within the standard of care (n=8420). CONCLUSIONS: Subclinical pre-HF affects approximately one-fourth of the at-risk population in rural and underresourced regions. The HERZCHECK approach identifies patients suitable for targeted preventive interventions ≈7 years earlier than the standard of care. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05122793.
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Kelle et al. (2026) conducted a cross-sectional in Subclinical pre-heart failure (n=4,509). Telemedically supervised mobile cardiac magnetic resonance screening vs. Standard of care (claims data control cohort) was evaluated on Time difference between detection of subclinical pre-HF and first symptom-based diagnosis of HF within standard of care (Mean difference 6.7 years, 95% CI 6.11-7.25, p=<0.001). Mobile cardiac magnetic resonance screening using global longitudinal strain identified subclinical pre-heart failure 6.7 years earlier than standard of care symptom-based diagnosis.
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