Key result
Cardiac MRI-derived diastolic function metrics predict incident heart failure and arrhythmia beyond conventional markers.
Why the study?
The prognostic value of cardiac MRI–derived diastolic function metrics for adverse cardiovascular outcomes beyond clinical risk factors and conventional imaging markers was unclear.
Do cardiac MRI-derived diastolic function metrics predict adverse cardiovascular outcomes in a general population cohort?
Cohort (n=59,416)
Yes
Do cardiac MRI-derived diastolic function metrics predict adverse cardiovascular outcomes in a general population cohort?
Hazard Ratio: 0.55 (95% CI 0.5–0.61)
p-value: p=<.001
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Ultimately, the clinical value of cardiac MRI–derived diastolic assessment will depend not only on technical standardization but also on demonstrating incremental value beyond established echocardiographic assessment. Its greatest strength may ultimately lie in integrating diastolic function with tissue characterization, myocardial deformation, and cardiac morphology within a single comprehensive cardiac MRI examination.”
“Further validation in diverse populations is important to confirm these results and establish age-, sex-, and race and ethnicity–specific reference ranges to facilitate translation into clinical practice.”
Cardiac MRI-derived diastolic function metrics, particularly peak e'SR, independently predict incident heart failure and arrhythmia with incremental prognostic value beyond established imaging markers like LVEF and GLS.
Background Although diastolic function markers can help predict adverse outcomes in cardiac disease, the prognostic value of cardiac MRI-derived metrics at a population level remains unclear. Purpose To assess the independent and incremental prognostic value of cardiac MRI-derived diastolic function metrics for adverse cardiovascular outcomes in the UK Biobank. Materials and Methods This secondary analysis of the UK Biobank used data from participants enrolled between March 2006 and August 2010. Univariable and multivariable Cox models were used to evaluate the prognostic influence of each diastolic function marker (peak early to peak late mitral filling rate ratio [E/A], peak early diastolic longitudinal strain rate [e'SR], peak early mitral filling rate to peak e'SR ratio [E/e'SR], and maximum left atrial volume [LAVmax]) on adverse outcomes, including heart failure (HF), arrhythmia, and all-cause death. Multivariable models were adjusted for clinical cardiovascular risk factors (age, sex, smoking, body mass index, hypertension, diabetes, and hyperlipidemia) and known prognostic imaging markers (left ventricular [LV] ejection fraction [LVEF], global longitudinal strain [GLS], LV end-diastolic volume index, and LV mass index). Results The cohort included 59 416 individuals (mean age, 65.4 years ± 7.7 [SD]; 30 887 women) with a median follow-up of 6 years. Peak e'SR, E/A, and LAVmax were independently associated with incident HF and arrhythmia, with peak e'SR showing the strongest association (hazard ratio [HR], 0.55 [95% CI: 0.50, 0.61] for HF, 1.37 [95% CI: 1.26, 1.49] for E/e'SR, and 1.28 [95% CI: 1.17, 1.40] for LAVmax; all P < .001). E/e'SR provided incremental value beyond LVEF and GLS. There was no evidence that diastolic markers were associated with incident all-cause death in fully adjusted models. Conclusion Cardiac MRI-derived diastolic function metrics independently predicted HF and arrhythmia in the UK Biobank with incremental value beyond established imaging markers.
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Mahmood et al. (2026) conducted a cohort in General population (n=59,416). Cardiac MRI-derived diastolic function metrics (peak e'SR, E/A, E/e'SR, LAVmax) was evaluated on Incident heart failure (HF) and arrhythmia (HR 0.55, 95% CI 0.50-0.61, p=<.001). Cardiac MRI-derived peak early diastolic longitudinal strain rate (peak e'SR) was strongly associated with incident heart failure (HR 0.55; 95% CI 0.50-0.61; P<0.001).
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