Atrial dysfunction: a contrast-free marker for HFpEF in obese diabetics—insights from comprehensive CMR and serum biomarker analyses

PMCID: PMC12175437

PMID: 40533773

DOI: 10.1186/s12933-025-02808-3

Journal: Cardiovascular diabetology

Publication Date: 2025-6-18

Authors: Beyer RE, Müller ML, Doeblin P, Werhahn SM, Chiribiri A, et al.

Key Points

• Left atrial function metrics provide the most reliable CMR-based differentiation of HFpEF from similar clinical conditions
• LA maximum volume showed the strongest discriminatory power, with an odds ratio of 1.13 (95% CI 1.05–1.28)
• Serum biomarkers like Galectin-3 and Pentraxin-3 were elevated in HFpEF but lack definitive diagnostic specificity

Summary

This exploratory study investigated the diagnostic potential of advanced cardiac magnetic resonance (CMR) imaging and serum biomarkers in heart failure with preserved ejection fraction (HFpEF), particularly in the context of obesity and type 2 diabetes mellitus (T2DM). The research focused on distinguishing HFpEF from associated comorbid conditions through comprehensive imaging and biomarker analysis of 35 participants across different clinical groups.

The most significant finding was the emergence of left atrial (LA) structural and functional metrics as independent discriminators of HFpEF. Multivariable regression revealed that LA maximum volume (OR 1.13, 95% CI 1.05–1.28), reservoir strain (OR 0.71, 95% CI 0.44–0.89), conduit strain (OR 0.57, 95% CI 0.32–0.82), and booster strain were the most precise markers. Notably, traditional markers of diffuse fibrosis and microvascular dysfunction did not effectively differentiate HFpEF from obese or diabetic controls, suggesting that LA function may represent a more nuanced diagnostic approach.