The Diagnostic and Prognostic Value of Cardiac Magnetic Resonance Strain Analysis in Heart Failure with Preserved Ejection Fraction

Q: What are the key findings of this study?

Combined CMR left ventricular strain analysis yielded high diagnostic accuracy for HFpEF (AUC 0.858, P<0.001) and predicted death or HF readmission (AUC 0.722, P=0.004).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with preserved ejection fraction (HFpEF) (n=166). Intervention: Combined left ventricular strain analysis on cardiac magnetic resonance (CMR) vs. Control participants without heart failure (and individual CMR strain parameters). Primary outcome: Diagnosis of HFpEF and composite prognostic endpoint of mortality or hospital readmission for heart failure (AUC 0.858 for diagnosis; AUC 0.722 for prognosis, 95% CI 0.798-0.919, p=<0.001).

Q: What does this research mean for the field?

Combined cardiac magnetic resonance left ventricular strain analysis provides high diagnostic accuracy for heart failure with preserved ejection fraction and significantly predicts clinical adverse outcomes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Shiwen Zhang; Yufei Zhou; Shuguang Han; Yanfang Ma; Cheng Wang; Yinglong Hou

doi:10.1155/2023/5996741

February 6, 2023Contrast Media & Molecular ImagingOpen Access

The Diagnostic and Prognostic Value of Cardiac Magnetic Resonance Strain Analysis in Heart Failure with Preserved Ejection Fraction

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Key result

Combined CMR LV strain accurately diagnoses HFpEF with an AUC of ~0.86 and predicts adverse outcomes.

AUC 0.858 for diagnosis; AUC 0.722 for prognosis
95% CI 0.798-0.919
P<0.001
n=166

Figures

Why the study?

The diagnostic and prognostic value of cardiac magnetic resonance strain analysis in heart failure with preserved ejection fraction needed to be identified.

Does combined left ventricular strain analysis on cardiac magnetic resonance improve diagnostic accuracy and prognostic prediction of mortality or heart failure readmission in patients with heart failure with preserved ejection fraction (HFpEF)?

Study Design

Type

Cohort (n=166)

Blinding

CMR images were evaluated by a single observer who was blinded to all data

Multicenter

No

Structured PICO

Does combined left ventricular strain analysis on cardiac magnetic resonance improve diagnostic accuracy and prognostic prediction of mortality or heart failure readmission in patients with heart failure with preserved ejection fraction (HFpEF)?

P

Population

166 participants (97 with HFpEF, mean age 58.87 years; 69 controls without HF, mean age 43.62 years) recruited at a single tertiary cardiac center in China and followed for a median of 483 days in the HFpEF group and 862 days in controls.

E

Exposure

Cardiac magnetic resonance (CMR) myocardial strain analysis (1.5 T scanner), evaluating global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) in the left ventricle (LV), right ventricle (RV), and left atrium (LA), both individually and as a combined LV strain analysis.

C

Comparator

Control participants free of HF symptoms with LVEF ≥50% and free of echocardiographic signs of severe diastolic dysfunction (n=69); also compared individual chamber strain parameters against combined LV strain parameters.

O

Outcome

Diagnostic accuracy for HFpEF (evaluated via ROC curve and AUC) and prognostic prediction of a composite clinical endpoint of mortality or readmission to hospital for HF at median follow-up of 483 days (IQR 240, 590) in the HFpEF group and 862 days (IQR 552, 1233) in the control group.composite

Main Result

Effect estimate: AUC 0.858 for diagnosis; AUC 0.722 for prognosis (95% CI 0.798-0.919)

Absolute Event Rate: 16.5% vs 0%

p-value: p=<0.001

Limitations

Single-center study at a provincial hospital, limiting generalizability
Insufficient occurrence of endpoint events (16 composite events) to perform Cox-regression analysis
Unknown whether strain analysis is valuable in HF with mildly reduced or improved ejection fraction
Right atrial (RA) strain analysis was not included
Single-center provincial hospital study, limiting generalizability to other hospitals
Insufficient occurrence of endpoint events (16 events in HFpEF group), preventing Cox-regression analysis
Did not evaluate whether individual or combined strain analysis is valuable in HF with mildly reduced ejection fraction or HF with improved ejection fraction
Right atrium (RA) strain analysis was not performed

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Implication

Combining left ventricular global longitudinal, circumferential, and radial strain on cardiac MRI provides superior diagnostic accuracy for HFpEF and significant prognostic value for predicting mortality or HF hospitalization compared to single strain parameters alone.

Abstract

Background. Strain analysis of cardiac magnetic resonance (CMR) is critical for the diagnosis and prognosis of heart failure (HF) with preserved ejection fraction (HFpEF). Our study aimed to identify the diagnostic and prognostic value of strain analysis revealed by CMR in HFpEF. Methods. Participants in HFpEF and control were recruited according to the guideline. Baseline information, clinical parameters, blood samples were collected, and echocardiography and CMR examination were performed. Various parameters, including global longitudinal strain, global circumferential strain (GCS) and global radial strain in left ventricle (LV), right ventricle (RV), and left atrium, were measured from CMR. Receiver operator curve (ROC) was established to evaluate the diagnostic and prognostic value of strains in HFpEF. Results. Seven strains, with the exception of RVGCS, were employed to generate ROC curves after t-test. All strains had significant diagnostic value for HFpEF. The area under curve (AUC) of LV strains was greater than 0.7 and the AUC of the combined analysis of LV strains was 0.858 (95% confidence interval (CI): 0.798–0.919, sensitivity: 0.713, specificity: 0.875, <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>P</a:mi> <a:mo><</a:mo> <a:mn>0.001</a:mn> </a:math> ), indicating that they had a higher diagnostic value than individual LV strains. However, individual strains had no predictive value in identifying end-point events in HFpEF, the AUC of coanalysis of LV strains was 0.722 (95% CI: 0.573–0.872, sensitivity: 0.500, specificity: 0.959, <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>P</c:mi> <c:mo>=</c:mo> <c:mn>0.004</c:mn> </c:math> ), indicating its prognostic relevance. Conclusion. Individual strain analysis in CMR may be useful for diagnosing HFpEF, the combination of LV strain analysis had the highest diagnostic value. Moreover, the prognostic value of individual strain analysis in predicting HFpEF outcome was not satisfactory while the combined usage of LV strain analysis was prognostically valuable in HFpEF outcome prediction.

Discussion

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Cite This Study

Zhang et al. (2023) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=166). Combined left ventricular strain analysis on cardiac magnetic resonance (CMR) vs. Control participants without heart failure (and individual CMR strain parameters) was evaluated on Diagnosis of HFpEF and composite prognostic endpoint of mortality or hospital readmission for heart failure (AUC 0.858 for diagnosis; AUC 0.722 for prognosis, 95% CI 0.798-0.919, p=<0.001). Combined CMR left ventricular strain analysis yielded high diagnostic accuracy for HFpEF (AUC 0.858, P<0.001) and predicted death or HF readmission (AUC 0.722, P=0.004).

synapsesocial.com/papers/6a79ab7064a23396470223d9 https://doi.org/10.1155/2023/5996741

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The Diagnostic and Prognostic Value of Cardiac Magnetic Resonance Strain Analysis in Heart Failure with Preserved Ejection Fraction

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Diagnostic and Prognostic Value of Cardiac Magnetic Resonance Strain Analysis in Heart Failure with Preserved Ejection Fraction

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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