ISMRM - SCMR Workshop

ISMRM - SCMR Workshop: Oral Session 4: Clinical Applications of Microstructure, Strain and Motion Encoding

Oral Abstract 4: Risk Stratification and Outcomes in Diabetes Mellitus Patients with Preserved Ejection Fraction: A CMR strain analysis study

Wednesday, January 29, 2025

2:15 PM – 2:25 PM East Coast USA Time

Location: Blue Room

Presenting Author(s)

wY

wenJing Yang, PhD

Dr
Fuwai Hospital, Chinese National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China (People's Republic)

Co-Author(s)

LZ

Leyi Zhu, PhD

Dr
Fuwai Hospital, China (People's Republic)

Primary Author(s)

ML

Minjie Lu, MD

PhD
Fuwai hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China (People's Republic)

Co-Author(s)

ML

Minjie Lu, MD

PhD
Fuwai hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China (People's Republic)

Background: Patients with diabetes mellitus(DM) have a significantly increased risk of developing heart failure(HF), which exacerbates adverse cardiovascular outcomes. Limited data are available on the prognostic value of MRI in DM at different HF stages. We aimed to evaluate the association between MRI-derived left ventricular strain analysis and primary composite outcome in DM patients at different AHA/ACC HF stages.

Methods: In this prospective study, DM participants with preserved ejection fraction(EF) underwent MRI examination between January 2019 and December 2021 were evaluated. Feature tracking strain parameters were measured using cine MRI. The risk factors for the primary outcome were identified with multivariate Cox analysis.

Results: A total of 581 DM participants(mean age, 56 years±13; 401 men) including 390 asymptomatic patients(stage A/B HF) and 191 heart failure with preserved EF were evaluated. During a median follow-up of 34.3 months, 74 DM patients experienced primary outcome. Kaplan-Meier survival curves showed that patients with global longitudinal strain(GLS) greater than or equal to -13.64% and patients with early diastolic longitudinal strain rate(eGLSR) less than or equal to 0.51/s were more likely to experience primary outcome(log-rank P< 0.001). For risk stratification category based on GLS and eGLSR, the groups with abnormal eGLSR had significantly higher risk of developing primary outcome, regardless of whether GLS was abnormal or not. In multivariate analysis, eGLSR was independently associated with increased risk of the primary endpoint(per SD, adjusted HR: 2.211; 95% CI: 1.584-3.086; P< 0.001), and provided incremental predictive power to clinical and imaging variables, with the largest C-statistic of 0.749.

Conclusion: Left ventricular early diastolic longitudinal strain rate obtained from cardiac MRI was independently associated with adverse outcomes in DM patients with preserved ejection fraction, and provided incremental value beyond conventional clinical and imaging indices.