Cardiac MRI biomarkers show prognostic value in heart failure studies
Two studies found cardiac MRI-derived biomarkers may improve heart failure risk assessment. Epicardial adipose tissue index was linked to HFpEF risk, while imaging-derived SvO2 predicted hospitalization and death.
Cardiac magnetic resonance imaging derived biomarkers may provide a useful tool to identify patients at higher risk of heart failure and its complications. New findings showed that epicardial adipose tissue volume quantified on cardiac magnetic resonance imaging was linked to HFpEF risk and prognosis, while cardiac MRI scans also offered a noninvasive way to derive mixed venous oxygen saturation measurements that were predictive of heart failure hospitalization and death.
In a retrospective analysis, investigators used cardiac magnetic resonance imaging to assess 117 patients with HFpEF, 62 high-risk individuals, and 65 healthy controls. EAT volume and left ventricular strain parameters were quantified using CVI42 software, reflecting routine post-processing workflows in cardiac imaging. The EAT index demonstrated a stepwise increase across groups, from 20.32 ml/m2 in controls to 31.98 ml/m2 in high-risk individuals and 48.21 ml/m2 in HFpEF patients.
Multivariable modelling incorporating strain parameters identified EATi and left ventricular global longitudinal strain as independent indicators linked to HFpEF. Follow-up data from 228 participants over a median of 31 months showed that higher EAT index was linked to an increased risk of heart failure readmission or all-cause mortality. Incremental rises in EAT index were also associated with higher risk of heart failure readmission or all-cause death.
Researchers also showed that cardiac MRI scans offer a noninvasive way to capture SvO2 measurements that are otherwise obtained with invasive right heart catheterization. A cohort of 30 underwent CMR T2 mapping and invasive right heart catheterization to test iSvO2 modeling, and the model was then tested in a validation cohort of 628 patients with recently diagnosed heart failure. Overall, iSvO2 was an independent predictor of mortality and heart failure hospitalization.
It is known that invasively measured mixed venous saturation of below 60% in patients with heart failure is a marker of adverse outcomes. The findings replicated this noninvasively, with iSvO2 being predictive of a composite of heart failure hospitalization and death, even after adjustment for age, sex, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and NYHA functional class. The authors also wrote that iSvO2 is a better predictor of outcome than either LVEF or NT-proBNP.
These findings position cardiac magnetic resonance imaging derived EAT volume as a potential imaging biomarker that reflects both disease severity and prognosis, expanding the role of cardiac MRI beyond conventional functional assessment. The ability to extract incremental diagnostic and prognostic information from standard imaging datasets may enhance multidisciplinary decision-making, although the retrospective design and need for prospective validation remain important limitations for the HFpEF analysis.