Heart Failure With Preserved Ejection Fraction In Post Myocardial Infarction Patients:a Myocardial Magnetic Resonance (MR) Tissue Tracking Study

Background: This study aimed to explore the value of cardiac magnetic resonance tissue tracking(CMR-TT)technology in evaluating heart failure with preserved ejection fraction(HFp EF)in patients with chronic myocardial infarction(CMI).Method: Between June 2016 and March 2022,we included a consecutive series of 92 patients with CMI and 40 healthy controls in this retrospective study.The CMI patients enrolled were divided into different subgroups [HFp EF-CMI group(n=54)and non-heart failure(HF)-CMI group(n=38)] according to the Heart Failure Association(HFA)-PEFF diagnostic algorithm.Quantitative measurements of myocardial damage,such as myocardial strain parameters of both ventricles derived by CMR-TT and infarct size and transmurality by late gadolinium enhancement(LGE),were assessed.One-way analysis of variance,independent samples t-test,and rank sum test were used to compare myocardial impairment among groups.Pearson or Spearman correlation coefficient was used to measure correlations between left ventricular(LV)strains and clinical and functional parameters.Logistic regression analysis and receiver operating characteristic(ROC)curve were performed to identify the best parameter for diagnosing HFp EF-CMI.The comparisons of models were performed with the R software by calculating the net reclassification index(NRI).Results: HFp EF-CMI patients demonstrated significantly impaired LV strains and strain rates in all of the three directions(radial,circumferential and longitudinal)compared to non-HF-CMI patients and healthy controls(P<0.001 for all),whereas only global longitudinal strain(GLS)was significantly impaired in HFp EF-CMI patients vs.controls for right ventricular strain parameters(P<0.001).L V strains showed moderate correlation with N-terminal pro-brain natriuretic peptide(radial,circumferential and longitudinal strain,R=-0.401,R=0.408,R=0.407,respectively,P<0.001 for all).L V strains in the three directions(radial,circumferential and longitudinal)[area under ROC curve(AUC)0.707,95% confidence interval(CI): 0.603–0.797;AUC 0.708,95% CI: 0.604–0.798;AUC 0.731,95% CI: 0.628–0.818;respectively,P<0.01 for all] were discriminators for HFp EF-CMI and non-HF-CMI.LV strains and myocardial infarction volume were independent factors in multi-logistic regression analysis after adjusting for body mass index,age,and sex(P<0.05 for all).Conclusions: CMR-TT provides clinicians with useful additional imaging parameters to facilitate the assessment of CMI patients with HFp EF.LV strain parameters can detect early cardiac insufficiency in patients with HFp EF-CMI and have potential value for discriminating between HFp EF and non-HF patients post-CMI.