Study On Multiple Subtypes And Risk Model Construction Of Heart Failure With Preserved Ejection Fraction Based On Magnetic Resonance Imagin

Background:Despite current recommendations for heart failure with preserved ejection fraction(HFpEF),few studies have demonstrated the ability of cardiovascular magnetic resonance(CMR)to identify subtle functional differences between HFpEF with essential hypertension(HFpEF-HTN)patients and hypertension patients(HTN),and subsequent its prognosis.This study aimed to detect and evaluate HFpEF in patients with HTN using feature-tracking(FT)and to ascertain optimal strain cutoffs for the diagnosis of HFpEFHTN.Then to investigate the risk factors affecting the prognosis of HFpEF-HTN patients.Methods:In this retrospective study,we included consecutive patients admitted to Fuwai hospital in China who underwent CMR between January 1,2010 and December 31,2018.Patients with HFpEF or hypertension were diagnosed with demographic data,clinical presentation,laboratory test,and echocardiography or CMR imaging.Participant data were obtained from the electronic medical records database or inquiry.The key exclusion criteria were primary cardiomyopathy,primary valvular heart disease,and coronary artery disease.Comparisons of clinical features and CMR derived structural and functional parameters amongst different groups were made using one-way analysis of variance,or χ2 test,and post hoc Bonferroni analysis where appropriate.The composite endpoint was allcause death or heart failure hospitalization.Kaplan-Meier curve and Log-rank test were used to compare the event-free survival rate of patients,and uni-and multi-variable Cox analysis were performed.Results:631 participants(425 with HFpEF-HTN;101 with HTN;and 105 healthy controls)were finally included into analysis.Compared to HTN patients and healthy controls,HFpEF-HTN patients demonstrated significantly impaired left ventricular(LV)strains(P<0.05 for all).LV global longitudinal strain(GLS)and early-diastolic strain rates were significantly impaired in HTN patients versus controls(all P<0.05).Compared with traditional CMR parameters,the early-diastolic strain rates showed better diagnostic value for the differentiation of HFpEF-HTN patients from HTN patients(AUC,0.689-0.733),and early-diastolic longitudinal strain rate(eGLSR)and early-diastolic radial strain rate(eGRSR)remained independently associated with the diagnosis of HFpEF-HTN in multivariable logistic analysis.Moreover,in multivariable Cox analysis,NYHA Ⅲ/Ⅳ(HR=2.74,P=0.001),left atrial volume index(LAVi)>45.9 ml/m2(HR=3.32,P<0.001)and eGLSR≤0.57/s(HR=2.62,P<0.001)were independently associated with the all-cause death or HF hospitalization in HFpEF-HTN patients,providing higher C-index(0.715).Conclusions The left ventricular strain parameters can well evaluate the cardiac systolic and diastolic dysfunction of HFpEF-HTN patients,and the early diastolic strain rate is superior to the traditional structural parameters in differentiating HFpEF-HTN from HTN patients.Early-diastolic longitudinal strain rate is a good diagnostic marker and an independent risk factor for HFpEF-HTN patients,and has important indication for risk stratification.Background:The pathophysiology and subsequent myocardial dysfunction of heart failure with preserved ejection fraction(HFpEF)with comorbid obesity has not been extensively described.This study aimed to investigate the clinical features and cardiovascular magnetic resonance(CMR)derived myocardial strain and tissue characteristics in patients with HFpEF and comorbid obesity phenotype.Methods:In this prospective cohort study,we included consecutive patients admitted to Fuwai hospital in China who underwent CMR between January 1,2019 to July 31,2021.Through the electronic medical records database or inquiry,patients with HFpEF or obesity were diagnosed with demographic data,clinical presentation,laboratory test,and echocardiography or CMR imaging.The key exclusion criteria were primary cardiomyopathy,primary valvular heart disease,and significant coronary artery disease.Comparisons of clinical features and CMR derived structural and functional parameters amongst different groups were made using one-way analysis of variance,or χ2 tests,and post hoc Bonferroni analysis where appropriate.Results:280 participants(108 patients with HFpEF and obesity,50 patients with HFpEF and normal weight,72 patients with obesity,and 50 healthy controls)were finally enrolled.Compared with patients with HFpEF and normal weight,patients with HFpEF and obesity were youmger males,and had higher plasma volume,uric acid and hemoglobin levels,yet less often atrial fibrillation,and lower NT-proBNP levels,and had higher left ventricular mass index,end-diastole/systole volume index,lower left atrial volume index,and worse myocardial strains(all P<0.05),but no remarkable difference in late gadolinium enhancement(LGE)presence and extracellular volume fraction(ECV).After adjusting for age,atrial fibrillation,and coronary artery disease,only global longitudinal strain(GLS,P=0.031)and early-diastolic global longitudinal strain rate(eGLSR,P=0.043)were considerably worse in patients with HFpEF and obesity versus patients with HFpEF and normal weight.Furthermore,early-diastolic strain rates showed no linear association with ECV in patients with HFpEF and obesity.Moreover,GLS demonstrated the highest diagnostic ability when compared with traditional CMR structural parameters and ECV to diagnose patients with HFpEF and obesity in the setting of obese.Conclusions:Higher systemic inflammation,and worse GLS and eGLSR may be the distinct features of obesity-related HFpEF phenotype;strains and ECV may represent different mechanisms of HFpEF with obesity,deserving further study.Background:The rate of hospitalization and mortality in patients with heart failure with preserved ejection fraction(HFpEF)are increasing.However,most current risk models are based on a broad spectrum of chronic heart failure,and there are relatively few risk models targeted to HFpEF patients.This study aimed to explore the independent risk factors of adverse end points in HFpEF patients based on CMR imaging,establishing a simple,feasible and objective risk model for HFpEF,and assisting in the early risk assessment.Methods:HFpEF patients who underwent CMR examination in Fuwai hospital from January 2010 to December 2018 were retrospectively included.The demographic data,clinical presentation,laboratory test,and CMR data were recorded,and the patients were followed up by telephone and medical records.The primary endpoint was all-cause death or heart failure hospitalization.Cox proportional hazards model was used to develop the model,and the internal and external validation were made.Results:1188 HFpEF patients were finally included into analysis,of which 926 HFpEF(80%)were used to generate the risk model(training group),and 262 HFpEF(20%)were used to validate the risk model(validation group).With a median follow-up of 6.0(4.18.4)years,a total of 328 patients reached the primary end point(cumulative event rate 35.4%).Age(HR=1.01,P=0.016),NYHA Ⅲ/Ⅳ(HR=1.42,P=0.013),the history of hospitalization for heart failure in the past year(HR=1.54,P=0.002),hypersensitive Creactive protein(HR=1.04,P=0.026)and glomerular filtration rate(HR=0.99,P=0.015),left atrial maximum volume index(LAVi)>44.6 m1/m2(HR=1.59,P<0.001),early diastolic longitudinal strain rate(eGLSR)≤ 0.56/s(HR=2.51,P<0.001),late gadolinium enhancement(LGE)>0%(HR=1.35,P=0.019)were independently associated with the main endpoints.The C-index of the model is 0.704,and the internal and external validation was good.In LGE-negative HFpEF group,age,hypersensitive C-reactive protein,Lg NTproBNP,LAVi>44.6 ml/m2(HR=1.48;95%Cl 1.02-2.14,P=0.040),and eGLSR≤0.57/s(HR=3.13;95%CI 2.19-4.49,P<0.001)were independently associated with primary endpoints.The C-index of the model is 0.718.Internal and external validation was good.Conclusions:Through the screening and integration of clinical,laboratory and imaging risk factors,our study has established and verified a new risk model for predicting allcause death or heart failure hospitalization in patients with HFpEF,especially in HFpEF patients with negative LGE.This model may optimize the early risk stratification and treatment strategy of HFpEF patients.