Introduction
Methods
Study population
CMR protocol
Image analysis
Statistical approach
Results
Demographics
Healthy controls (n = 70) | At risk for heart failure (n = 126) | HFpEF (n = 87) | p-value 1 | HFmrEF (n = 88) | HFrEF (n = 58) | p-value 2 | |
---|---|---|---|---|---|---|---|
Preserved ejection fraction | |||||||
Age, year | 59 (52,69)*† | 65 (60,72)* | 73 (64,81) | < 0.001 | 70 (60,75)¶ | 66 (59,77)¶ | 0.005 |
Male | 29 (37.1%) | 53 (42.1%) | 34 (39.1%) | 0.78 | 61 (69.3%) | 40 (69.0%) | < 0.001 |
BMI, (kg/m2) | 28 (24,30)*† | 29 (25,34)* | 30 (28,35) | < 0.001 | 29 (26,33)¶ | 29 (26,32)¶ | 0.013 |
Systolic blood pressure, (mmHg) | 128 (116,140)† | 137 (123,151) | 130 (121,146) | 0.070 | 125 (115,136)¶ | 124 (111,133)¶ | 0.006 |
Heart rate, bpm | 67 (60,76) | 68 (61,76) | 64 (60,76) | 0.16 | 64 (60,75) | 68 (60,76) | 0.30 |
NYHA Class | 2.1 ± 0.7 | N/A | 1.9 ± 0.7 | 2.0 ± 0.7 | 0.30 | ||
Coronary artery disease | 0 | 22 (17.5%) | 37 (42.5%) | < 0.001 | 40 (45.5%) | 29 (50%) | 0.68 |
Hypertension | 0 | 100 (79.4%) | 75 (86.2%) | < 0.001 | 56 (63.6%) | 37 (63.8%) | 0.001 |
Atrial fibrillation/flutter | 0 | 19 (15.1%) | 34 (39.1%) | < 0.001 | 36 (40.9%) | 23 (39.7%) | 0.98 |
Chronic obstructive pulmonary disease | 0 | 8 (6.4%) | 18 (20.1%) | < 0.001 | 15 (17.1%) | 12 (20.7%) | 0.79 |
Chronic kidney disease | 0 | 9 (7.1%) | 22 (25.3%) | < 0.001 | 17 (19.3%) | 11 (19.0%) | 0.55 |
Beta blocker | 0 | 34 (27.0%) | 64 (73.6%) | < 0.001 | 79 (89.8%)¶ | 54 (93.1%)¶ | 0.001 |
ACEi or ARB | 0 | 86 (68.3%) | 73 (83.9%) | < 0.001 | 76 (83.6%) | 50 (86.2%) | 0.88 |
NT-proBNP (pmol/l) | 5 (3,10)*† | 7 (4,16)* | 66 (19,132) | < 0.001 | 57 (24,147) | 104 (52,253)¶§ | 0.003 |
Creatinine (mol/l) | 78 (67,86)* | 77 (67,89)* | 96 (76,123) | < 0.001 | 97 (80,122) | 93 (77,110) | 0.49 |
Healthy controls (n = 70) | At risk for heart failure (n = 126) | HFpEF (n = 87) | p-value 1 | HFmrEF (n = 88) | HFrEF (n = 58) | p-value 2 | |
---|---|---|---|---|---|---|---|
Preserved ejection fraction | |||||||
LVEF (%) | 63 (61,67)† | 66 (62,70)* | 63 (59,68) | 0.008 | 48 (44,52) ¶ | 32 (25,38)¶§ | < 0.001 |
LVEDVI (ml/m2) | 74 (68,83) | 75 (65,87) | 76 (68,86) | 0.73 | 100 (81,114)¶ | 134 (100,165)¶§ | < 0.001 |
LVESVI (ml/m2) | 27 (23,31) | 25 (21,31) | 28 (22,33) | 0.16 | 51 (40,62)¶ | 90 (64,121)¶§ | < 0.001 |
LVM index, (g/m2) | 55 (49,61)*† | 61 (51,71)* | 66 (56,79) | < 0.001 | 76 (63,88)¶ | 91 (74,110)¶§ | < 0.001 |
LVM/LVEDV | 0.72 (0.66,0.79)*† | 0.80 (0.70,0.91)* | 0.85 (0.73,0.98) | < 0.001 | 0.79 (0.66,0.88)¶ | 0.67 (0.60,0.76)¶§ | < 0.001 |
RWT | 0.31 (0.27,0.34) * | 0.32 (0.28,0.37)* | 0.34 (0.29,0.40) | 0.019 | 0.32 (0.27,0.37)¶ | 0.28 (0.24,0.32)¶§ | < 0.001 |
RVEF | 58 (55,64)† | 62 (57,67) * | 60 (52,64) | 0.021 | 52 (46,58)¶ | 49 (41,56)¶§ | < 0.001 |
RVEDVI, (ml/m2) | 74 (63,83) | 75 (61,88) | 71 (63,91) | 0.74 | 81 (67,97)¶ | 79 (68,108)¶ | 0.070 |
RVESVI, (ml/m2) | 30 (23,35) | 28 (22,35) | 31 (24,39) | 0.27 | 38 (28,48)¶ | 39 (31,57)¶ | < 0.001 |
GLS_EPI (%) | − 16.5 ± 2.4*† | − 15.5 ± 2.7* | − 14.1 ± 3.0 | < 0.001 | − 11.6 ± 2.1¶ | − 8.2 ± 2.2¶§ | < 0.001 |
GLS_AVE (% | − 19.6 ± 2.5* | − 19.2 ± 3.1* | − 17.9 ± 3.3 | < 0.001 | − 14.0 ± 2.3¶ | − 9.4 ± 2.7¶§ | < 0.001 |
GLS_ENDO (%) | − 21.1 ± 2.6 | − 21.2 ± 3.4 | − 20.1 ± 3.7 | 0.050 | − 15.3 ± 2.9¶ | − 10.0 ± 3.2¶§ | < 0.001 |
GLS_ENDO/GLS_EPI | 1.3 (1.2,1.4)*† | 1.4 (1.3,1.5)* | 1.4 (1.3,1.5) | < 0.001 | 1.3 (1.2,1.4)¶ | 1.2 (1.2,1.3)¶§ | < 0.001 |
Absolute GLS layer difference, (%) | − 4.7 (− 5.8, − 3.3)*† | − 5.7 (− 7.4, − 4.1) | − 5.6 (− 7.5, − 4.3) | < 0.001 | − 3.5 (− 5.1, − 2.3)¶§ | − 2.1 (− 2.7, − 1.0)¶§ | < 0.001 |
Relative GLS layer difference (%) | 21.9 (16.5,27.0)*† | 27.3 (20.4,32.5)* | 28.9 (23.4,34.4) | < 0.001 | 25.4 (16.1,29.9)¶§ | 17.9 (13.4,25.8)¶§ | < 0.001 |
GCS_EPI (%) | − 11.1 ± 2.8 | − 10.2 ± 2.5 | − 10.2 ± 3.4 | 0.072 | − 7.8 ± 2.4¶ | − 5.7 ± 2.2¶§ | < 0.001 |
GCS_AVE (%) | − 19.9 ± 3.4 | − 19.9 ± 3.3 | − 19.3 ± 4.0 | 0.40 | − 13.9 ± 3.1¶ | − 9.3 ± 3.1¶§ | < 0.001 |
GCS_ENDO (%) | − 29.9 ± 4.7 | − 31.1 ± 5.3 | − 29.9 ± 6.1 | 0.17 | − 21.1 ± 4.9¶ | − 13.1 ± 4.6¶§ | < 0.001 |
GCS_ENDO/GCS_EPI | 2.6 (2.4,3.1)*† | 3.0 (2.6,3.6) | 2.9 (2.4,4.0) | 0.004 | 2.6 (2.3,3.3)¶ | 2.3 (1.9,2.9)¶§ | < 0.001 |
Absolute GCS layer difference (%) | − 18.8 (− 21.1, − 16.3)† | − 20.8 (− 24.3, − 17.8)* | − 19.0 (− 23.1, − 16.1) | 0.002 | − 13.0 (− 16.2, − 9.8)¶ | − 7.5 (− 8.7, − 5.1)¶§ | < 0.001 |
Relative GCS layer difference (%) | 61.8 (58.4,67.5) *† | 67.0 (62.1,72.1) | 65.4 (57.8,74.8) | 0.004 | 62.0 (57.1,69.2)¶ | 56.8 (47.4,64.9)¶§ | < 0.001 |
GRS_LAx (%) | 48.9 ± 10.7* | 47.5 ± 12.8* | 41.1 ± 13.8 | < 0.001 | 28.5 ± 9.4¶ | 18.7 ± 7.7¶§ | < 0.001 |
GRS_SAx (%) | 46.7 ± 12.4* | 46.3 ± 15.1* | 38.6 ± 16.7 | < 0.001 | 27.0 ± 9.0¶ | 17.7 ± 8.1¶§ | < 0.001 |
Ventricular structure and function
Layer-specific strain in healthy controls
Male (n = 29) | Female (n = 48) | p-value | |
---|---|---|---|
LVEF (%) | 62 (59,65) | 63 (60,67) | 0.50 |
GLS_EPI (%) | − 15.0 ± 2.4 | − 17.1 ± 2.3 | < 0.001 |
GLS_AVE (%) | − 18.7 ± 2.6 | − 20.5 ± 2.5 | 0.006 |
GLS_ENDO (%) | − 19.6 ± 2.6 | − 21.4 ± 2.7 | 0.005 |
GLS_ENDO/GLS_EPI | 1.32 ± 0.12 | 1.26 ± 0.11 | 0.035 |
Absolute GLS layer difference, % | − 5.0 (− 5.6, − 3.8) | − 4.2 (− 5.6, − 3.2) | 0.33 |
Relative GLS layer difference, % | 24.2 (20.1,28.0) | 19.7 (15.6,25.7) | 0.030 |
GCS_EPI (%) | − 9.6 ± 2.6 | − 11.6 ± 2.7 | 0.002 |
GCS_AVE (%) | − 18.5 ± 3.3 | − 20.1 ± 3.4 | 0.051 |
GCS_ENDO (%) | − 28.9 ± 4.7 | − 29.7 ± 4.9 | 0.50 |
GCS_ENDO/GCS_EPI | 2.97 (2.61,3.47) | 2.56 (2.32,2.86) | 0.001 |
Absolute GCS layer difference (%) | − 18.7 (− 21.7, − 16.6) | − 18.3 (− 20.4, − 15.8) | 0.29 |
Relative GCS layer difference (%) | 66.3 (61.6,71.2) | 61.0 (56.9,65.1) | 0.001 |
GRS_LAx (%) | 43.6 ± 10.6 | 50.6 ± 10.3 | 0.006 |
GRS_SAx (%) | 41.7 ± 11.7 | 49.1 ± 12.2 | 0.011 |
LVM index,g/m2 | 60 (57,71) | 52 (47,57) | 0.005 |
LVM/LVEDV | 0.81 (0.70,0.93) | 0.74 (0.64,0.83) | < 0.001 |
RWT | 0.34 (0.30,0.37) | 0.30 (0.26,0.32) | < 0.001 |
Clinical outcomes
Patients with HF or at risk for HF- 376 subjects (33 events) | |||||
---|---|---|---|---|---|
Univariable analysis | Multivariable analysis | ||||
HR (95% CI) | p-value | Model χ2 | HR (95% CI) | p-value | |
Age at CMR, per 10 year increase | 2.37 (1.58,3.56) | < 0.001 | 21.5 | ||
Male gender | 0.66 (0.32,1.34) | 0.25 | 1.4 | ||
BMI, per 1 kg/m2 increase | 1.00 (0.94,1.06) | 0.99 | 0.1 | ||
Systolic blood pressure, per 10 mmHg increase | 0.80 (0.66,0.98) | 0.031 | 0.2 | ||
Current smoker | 1.34 (0.93,1.91) | 0.12 | 2.6 | ||
History of heart failure | 6.43 (1.96,21.08) | 0.002 | 15.3 | ||
Hypertension | 1.07 (0.48,2.38) | 0.86 | 0.1 | ||
Coronary artery disease | 2.15 (1.11,4.17) | 0.023 | 5.1 | ||
Atrial fibrillation/flutter | 2.81 (1.42,5.58) | 0.003 | 8.6 | ||
Diabetes | 0.81 (0.39,1.70) | 0.58 | 0.3 | ||
COPD | 1.92 (0.87,4.26) | 0.11 | 2.3 | ||
Chronic kidney disease | 1.20 (0.50,2.91) | 0.69 | 0.2 | ||
Log (NT-proBNP), per 1 unit increase | 1.84 (1.44,2.36) | < 0.001 | 27.5 | ||
Log (Creatinine), per 1 unit increase | 3.20 (1.37,7.49) | 0.007 | 6.2 | ||
LVEF, per 10% decrease | 1.37 (1.10,1.71) | 0.004 | 7.6 | 1.22 (0.95,1.58) | 0.12 |
LVEDVI, per 10 ml/m2 increase | 1.09 (1.00,1.18) | 0.043 | 3.5 | 1.06 (0.97,1.15) | 0.19 |
LVESVI, per 10 ml/m2 increase | 1.11 (1.02,1.20) | 0.013 | 5.0 | 1.07 (0.97,1.17) | 0.16 |
LVM index, per 10 g/m2 increase | 1.14 (1.00,1.29) | 0.051 | 3.3 | 1.09 (0.95,1.25) | 0.25 |
LVM/LVEDV, per 0.1 increase | 0.98 (0.82,1.17) | 0.82 | 0.1 | 0.92 (0.81,1.03) | 0.14 |
GLS_EPI, per 1% absolute decrease | 1.11 (1.04,1.18) | 0.002 | 9.4 | 1.09 (0.98,1.22) | 0.11 |
GLS_AVE, per 1% absolute decrease | 1.14 (1.06,1.23) | < 0.001 | 12.5 | 1.10 (1.01,1.20) | 0.023 |
GLS_ENDO, per 1% absolute decrease | 1.10 (1.04, 1.18) | 0.002 | 9.2 LR chi2 (2) = 1 LR chi2 (2) = 1 | 1.06 (0.98, 1.15) | 0.15 |
GCS_EPI, per 1% absolute decrease | 1.01 (0.91,1.13) | 0.83 | 0.1 | 0.99 (0.90,1.10) | 0.87 |
GCS_AVE, per 1% absolute decrease | 1.05 (0.99, 1.12) | 0.10 | 2.6 | 1.02 (0.95,1.09) | 0.57 |
GCS_ENDO, per 1% absolute decrease | 1.04 (1.00,1.08) | 0.044 | 4.0 | 1.02 (0.98,1.06) | 0.41 |
GRS_LAx, per 1% decrease | 1.03 (1.01,1.05) | 0.001 | 12.2 | 1.03 (1.00,1.05) | 0.024 |
GRS_SAx, per 1% decrease | 1.03 (1.01,1.05) | 0.002 | 11.9 | 1.03 (1.00,1.05) | 0.019 |
AIC | ΔAIC | |
---|---|---|
BM + LVEF | 355.7 | 3.7 |
BM + LVEDVI | 356.5 | 4.5 |
BM + LVESVI | 356.4 | 4.4 |
BM + LVM indexi | 356.9 | 4.9 |
BM + GLS_EPI | 355.5 | 3.5 |
BM + GLS_AVE | 352.8 | 0.8 |
BM + GLS_ENDO | 355.7 | 3.7 |
BM + GCS_EPI | 358.1 | 6.1 |
BM + GCS_AVE | 357.5 | 5.5 |
BM + GCS_ENDO | 357.4 | 5.4 |
BM + GRS_LAx | 352.3 | 0.3 |
BM + GRS_SAx | 352.0 | 0 |