Heart failure & cardiomyopathies
Myocardial Tissue Characterization by Cardiac Magnetic Resonance (CMR) Captures Mechanistic Severity Beyond Filling Pressure in Heart Failure with Preserved Ejection Fraction (HFpEF): The Multicenter DECIPHER HFpEF Study
Authors' conclusion
In invasively characterized HFpEF, CMR tissue mapping captures active relaxation impairment and passive stiffness conditional on filling pressure, robust to clinical covariate adjustment.
Study context
- Population
- Patients with suspected HFpEF undergoing CMR with sequence-corrected tissue mapping and invasive pressure-volume loop analysis
- Participants
- 52 / 32 / 18
- Exposure
- CMR tissue mapping vs invasive pressure-volume loop indices in HFpEF
- HFpEFn = 52
- Matched controlsn = 32reference
- Healthy volunteersn = 18
- Outcome
- Association of CMR tissue mapping (T1c, T2c) with passive stiffness (β) and active relaxation (τ), adjusted for EDP
Methodological detailsmulticentre, 18 catheterized symptomatic patients with normal resting end-diastolic pressure (EDP) underwent handgrip provocation for a continuum analysis
- Multicentre
- 18 catheterized symptomatic patients with normal resting EDP underwent handgrip provocation for a continuum analysis
Main finding
As reported in the abstract
Partial correlations within HFpEF, conditional on EDP
Partial ρ
0.47
P = 0.003
T1c vs β
ρ
0.35
P = 0.018
T2c vs τ
Observational data: associations, not effects.
Further findings
| Outcome | Cliff's δ | P value |
|---|---|---|
| T1c and T2c, HFpEF vs matched controlsHFpEF vs Matched controls · T1c | 0.74 | P < 0.001 |
| T1c and T2c, HFpEF vs matched controlsHFpEF vs Matched controls · T2c | 0.80 | P < 0.001 |
Exploratory clustering on τ and β: 2 phenotypes (mild diastolic dysfunction (DD) n = 24, severe DD n = 28)
- Adjusted Rand index
- 0.78
- Phenotypes separated T1c and T2c
- both P < 0.001
- EDP median split did not separate T1c and T2c
- Exploratory, hypothesis-generating
Original publication
Myocardial Tissue Characterization by CMR Captures Mechanistic Severity Beyond Filling Pressure in HFpEF: The Multicenter DECIPHER HFpEF Study. JACC Cardiovasc Imaging. Published 16 September 2026. doi:10.
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