Myocardial Abnormalities Across the AHA/ACC Stages of Heart Failure in Patients With Diabetes.

Background: Cardiac magnetic resonance imaging (CMR) could serve as a robust tool for comprehensive evaluation of early changes across heart failure (HF) stages classified by the American Heart Association/American College of Cardiology guideline in diabetes mellitus (DM).

Objectives: The authors aimed to explore phenotypic imaging features characterizing DM participants at different HF stages by CMR.

Methods: DM participants with preserved ejection fraction who underwent CMR examination between January 2020 and December 2021 were evaluated. Left ventricular strain analysis and myocardial fibrosis was evaluated by CMR.

Results: A total of four hundred seventy-five DM participants at different HF stages (mean age 56 ± 12 years; 326 men) and 78 healthy control subjects were evaluated. Significantly decreased absolute strain values with rising HF stage were identified in DM. In addition, early diastolic strain rates were significantly lower in stage B and C HF than in stage A HF and control subjects. Myocardial extracellular volume increased with advancing HF stage in DM (stage A, 27.0% ± 2.9%; stage B, 29.1% ± 3.5%; stage C, 30.5% ± 4.1%;  < 0.05). In multivariable logistic regression analysis, early diastolic longitudinal strain rate (OR: 2.184; 95% CI: 1.378-3.461; 0.001) was a significant contributor that independently distinguished DM participants at stage A from control subjects, with an area under the receiver-operating characteristic curve of 0.726. For global longitudinal strain and extracellular volume, each 1% increase was associated with 1.333 and 1.300 times adjusted odds of diagnosis of stage B HF (both 0.05).

Conclusions: Subclinical dysfunction and myocardial fibrosis derived from CMR were progressively remarkable with advancing HF stage in DM. Comprehensive CMR provided sensitive tools for better delineation of DM patients with pre-HF and at risk for HF.