Mobile CMR to Improve Subclinical Heart Failure Detection in Rural Areas - HERZCHECK

Mar 31, 2025
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Author/Summarized by Author:
Kevin G. Tayon, MD
Summary Reviewer:
Fred M. Kusumoto, MD, FACC; Matthew W. Martinez, MD, FACC
Trial Sponsor:
G-BA Innovation Fund Germany
Date Presented:
03/30/2025
Date Updated:
03/31/2025
Original Posted Date:
03/31/2025
References

Contribution To Literature:

The HERZCHECK trial demonstrates the feasibility and diagnostic value of a mobile, CMR-based screening strategy for detecting asymptomatic stage B HF in rural, high-risk populations.

Description:

The goal of the trial was to evaluate the feasibility and diagnostic efficacy of a mobile, telemedically supervised screening approach, combining cardiovascular magnetic resonance imaging (CMR) and laboratory testing as central elements for detecting asymptomatic heart failure (HF) in rural, high-risk populations.

Study Design

Participants in structurally underserved rural regions of North-Eastern Germany received a comprehensive screening examination including medical history, laboratory testing, and CMR at baseline. Based on CMR-derived global longitudinal strain (GLS), participants were classified as stratum A (GLS < -15%), B (GLS ≥ -15% to < -11%), or C (GLS ≥ -11%), with strata B and C defined as asymptomatic pre-HF.

Ten percent of participants in stratum A and all of stratum B and C were subsequently randomized into two groups, receiving either conventional or innovative medical reports, the latter including information on GLS, guideline-based recommendations, and access to a lifestyle intervention app for cardiovascular prevention. Follow-up assessments were performed over 12 months to evaluate changes in GLS, as well as adverse cardiac events and quality of life.

  • Total number of enrollees: ≥4,500
  • Duration of follow-up: 1 year

Inclusion criteria:

Asymptomatic adults, aged 40-69 years, without a history of HF, but with at least one of the following cardiovascular risk factors:

  • Arterial hypertension
  • Hypercholesterolemia
  • Obesity
  • Smoking/tobacco consumption
  • Diabetes mellitus
  • Chronic kidney disease

Exclusion criteria:

  • Previously diagnosed with HF
  • CMR-specific criteria

Principal Findings:

The primary outcome, prevalence of asymptomatic stage B HF (defined as GLS ≥ -15%) in an at-risk rural population, was 23% (864 of 3,762 patients).

Secondary outcomes:

  • Mean age at diagnosis: 6.7 years earlier in HERZCHECK participants compared with historic control
  • Risk factors associated with impaired GLS included male sex (odds ratio [OR], 4.2; 95% CI, 3.6–4.9; p<0.001), obesity (OR, 1.5; 95% CI, 1.3–1.7; p<0.001), diabetes mellitus (OR, 1.7; 95% CI, 1.4–2.0; p<0.001), and smoking (OR, 1.4; 95% CI, 1.2–1.6; p<0.001)
  • Elevated NT-proBNP (≥125 pg/mL) was present in 32% (278 of 864) of patients with impaired GLS vs. 29% (830 of 2,898) with preserved GLS
  • One-year rate of freedom from HF hospitalization was 93% (786 of 842) among patients with impaired GLS (≥ -15%) compared with 98.0% (277 of 282) with preserved GLS (p=0.0017)

One-year survival rates were similar (p=0.22) between patients with impaired GLS (98%; 825 of 842) and without impaired GLS (99%; 279/282).

Interpretation:

The HERZCHECK trial demonstrates the feasibility and diagnostic value of a mobile, CMR-based screening strategy for detecting asymptomatic stage B HF in rural, high-risk populations. Nearly one in four participants had impaired GLS despite being asymptomatic, with detection occurring an average of 6.7 years earlier than in routine care.

These findings highlight the potential of mobile CMR programs to expand access to advanced cardiovascular imaging in underserved regions. However, the scalability and reproducibility of CMR-derived strain in routine clinical practice is still to be determined. Additionally, how identification of impaired GLS impacts management and if changes in management impact clinical outcomes is unknown.

References:

Presented by Dr. Sebastian Ulrich Kelle at the American College of Cardiology Annual Scientific Session (ACC.25), Chicago, IL, March 30, 2025.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Magnetic Resonance Imaging

Keywords: ACC25, ACC Annual Scientific Session, Heart Failure, Magnetic Resonance Imaging, Secondary Prevention, Social Determinants of Health


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