| Title: | Novel cardiovascular magnetic resonance strain heterogeneity phenotypes predict cardiovascular events: A prospective UK Biobank study |
| Journal: | Journal of Cardiovascular Magnetic Resonance |
| Published: | 29 Oct 2025 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41173274/ |
| DOI: | https://doi.org/10.1016/j.jocmr.2025.101976 |
Publication 19121
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Abstract
BACKGROUND: Global longitudinal (GLS), circumferential (GCS) and radial (GRS) strains may be insufficiently sensitive to early regional pathological cardiac remodeling on cardiovascular magnetic resonance imaging (CMR). Corresponding strain coefficients of variation, CoVLS, CoVCS and CoVRS, may facilitate improved prognostication by quantifying contractile heterogeneity.</p>
OBJECTIVES: To compare CoVLS, CoVCS, CoVRS, to GLS, GCS, GRS, to predict incident cardiovascular (CV) events at population level, respectively.</p>
METHODS: CMR feature tracking-derived strain biomarkers from 60,746 UK Biobank participants were calculated. Kaplan-Meier survival analysis and Cox proportional hazards regression analyzed unadjusted and adjusted associations between strain biomarkers and CV outcomes, respectively. Covariables included age, sex, CV risk factors, left ventricular mass, end-diastolic volume, ejection fraction (LVEF) and pre-existent regional strain abnormalities. Logrank test for trend, hazard ratios (HR) and Uno's C-Index compared relative performances of CoV and global strain.</p>
RESULTS: Over a median follow-up 5.1 years, higher CoVCS, CoVRS and lower GLS predicted greater risk of all-cause death (HR 1.10 [1.02-1.19]; HR 1.08 [1.01-1.16]; HR 0.84 [0.77-0.93], respectively) and a composite CV endpoint of myocardial infarction (MI), heart failure (HF) and arrhythmia (HR 1.10 [1.04-1.16]; HR 1.06 [1.01-1.12]; HR 0.77 [0.71-0.82], respectively). Model discrimination of HF and arrhythmia were significantly improved by CoVCS (△C-index 0.004 [P<0.001], 0.002 [P=0.001], respectively) and CoVRS (△C-index 0.004 [P<0.001], 0.001 [P=0.004], respectively). When LVEF ≥50% and ≥3 of age >65 years, obesity, hypertension, diabetes, atrial fibrillation and chronic kidney disease, CoVCS and CoVRS were more predictive of incident HF than GLS (HR 1.37 [1.14-1.65]; HR 1.35 [1.14-1.60]; HR 0.68 [0.53-0.86], respectively). When LVEF <50%, CoVCS and CoVRS were superior to GLS in predicting the composite CV endpoint, HF and arrhythmia (logrank test for trend, P<0.001 for all with CoVCS and CoVRS vs P=0.022, P=0.15, P=0.030 for GLS respectively).</p>
CONCLUSIONS: Heterogeneity biomarkers are sensitive to early pathological signals by measuring disease regionality. CoVCS and CoVRS are significant, consistent, additive and sometimes superior predictors of HF, arrhythmia and all-cause death than established risk markers, particularly in cohorts with multiple co-morbidities or LVEF <50%. Expansion of machine learning-guided image analysis makes strain CoV imminently translatable into routine clinical practice.</p>
22 Keywords
- Aged
- Biological Specimen Banks
- Cardiovascular Diseases
- Female
- Humans
- Incidence
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Myocardial Contraction
- Phenotype
- Predictive Value of Tests
- Prognosis
- Prospective Studies
- Risk Assessment
- Risk Factors
- Stroke Volume
- Time Factors
- UK Biobank
- United Kingdom
- Ventricular Function, Left
- Ventricular Remodeling
9 Authors
- Kerrick Hesse
- Mohammed Y. Khanji
- C. Anwar A. Chahal
- Sucharitha Chadalavada
- Kenneth Fung
- Jose D. Vargas
- Jose Paiva
- Steffen E. Petersen
- Nay Aung
1 Application
| Application ID | Title |
|---|---|
| 2964 | Description of cardiovascular phenotype in the UK Biobank population based on cardiovascular magnetic resonance and carotid ultrasound |
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