Cardiac MRI-derived diastolic function metrics, particularly peak early diastolic longitudinal strain rate, can independently predict heart failure and arrhythmia outcomes with greater accuracy than traditional clinical risk factors and established imaging markers.
- Four cardiac MRI metrics were analyzed in 59,416 individuals with a median six-year follow-up: peak early diastolic longitudinal strain rate, E/e′SR ratio, E/A ratio, and maximum left atrial volume.
- Peak e′SR showed the strongest association with heart failure, with a hazard ratio of 0.55.
- E/e′SR and maximum left atrial volume independently predicted both heart failure and arrhythmia, providing incremental value beyond traditional markers like LVEF and global longitudinal strain.
- Clinical implementation requires standardization of image acquisition, temporal resolution, and postprocessing algorithms across institutions.
- Age-, sex-, and race/ethnicity-specific reference ranges must be established to translate these findings into routine clinical practice.
Diastolic function markers derived from cardiac MRI exams can independently predict heart failure and arrythmia, yielding incremental value over clinical risk factors and established imaging markers, according to research published September 29 in Radiology.
The results, obtained from a secondary analysis of a large cohort in the UK Biobank, support more routine use of diastolic function assessment on cardiac MRI in clinical practice, according to a research team led by first author Adil Mahmood, MBBS, and corresponding author Nay Aung, MBBS, PhD, of Queen Mary University of London.
In the analysis of 59,416 individuals with a median follow-up of six years, the researchers assessed the value of four cardiac MRI-derived metrics: Peak early diastolic longitudinal strain rate (e′SR), peak peak early mitral filling rate to peak e′SR ratio (E/e′SR), early to peak late mitral filling rate ratio (E/A), and maximum left atrial volume (LAVmax).
They found that peak e′SR, E/A, and LAVmax were independently associated with incident HF and arrhythmia, with peak e′SR showing the strongest association with heart failure:
· Peak e′SR: hazard ratio [HR] for heart failure, 0.55 [95% CI: 0.50, 0.61]
· E/e′SR: HR, 1.37 [95% CI: 1.26, 1.49]
· LAVmax: HR, 1.28 [95% CI: 1.17, 1.40
What’s more, E/e′SR provided incremental value beyond traditional prognostic imaging markers left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS).
“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,” the authors wrote.
The authors noted, however, that none of the cardiac MRI diastolic function biomarkers predicted all-cause death after adjustment for clinical covariates.
In an accompanying editorial, Masaki Ishida, MD, PhD, of Mie University Hospital in Japan said that broader clinical implementation of this approach will require standardization of image acquisition, temporal resolution, and postprocessing algorithms.
“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,” he wrote. “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.”
The full study can be found here.
