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Challenges of Classifying Stage B Heart Failure in a High-Risk Population
Alice C Cowley1,2, Abhishek Dattani1,2, Jian L Yeo1,2
1Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK.
Journal of Cardiovascular Development and Disease
|January 27, 2026
Summary
Current guidelines for Stage B heart failure (SBHF) lack specificity. Refining criteria with sex- and ethnic-specific thresholds may better identify individuals at risk for symptomatic disease.
Area of Science:
- Cardiology
- Medical Imaging
- Diabetes Research
Background:
- Stage B heart failure (SBHF) poses a significant risk for developing symptomatic heart failure (HF).
- Existing diagnostic criteria for SBHF lack sex and ethnic specificity, and defined thresholds for cardiac magnetic resonance (CMR) imaging.
- There is a need to assess SBHF prevalence in diverse populations and refine diagnostic criteria.
Purpose of the Study:
- To evaluate the prevalence of SBHF in a large cohort of individuals with type 2 diabetes (T2D) and healthy controls.
- To propose refined, sex- and ethnic-specific CMR imaging criteria for diagnosing SBHF.
- To compare patient characteristics and exercise capacity between Stage A and Stage B HF classifications.
Main Methods:
- Derived sex- and ethnic-specific thresholds from 373 healthy controls using CMR cine imaging.
- Applied current and refined SBHF criteria to a cohort of asymptomatic individuals with T2D and to historical cohorts with symptomatic cardiovascular disease (aortic stenosis and HFpEF).
- Calculated SBHF prevalence, compared patient characteristics including exercise capacity, and assessed cardiac remodeling in symptomatic cohorts.
Main Results:
- Current criteria identified 91% of T2D individuals and 69% of healthy controls as SBHF, indicating poor specificity.
- Refined criteria, incorporating sex- and ethnicity-specific thresholds and echo/CMR measures, reduced SBHF prevalence to 30% in the T2D cohort.
- Individuals classified with refined Stage B HF exhibited lower exercise capacity compared to Stage A HF (81% vs. 91% predicted maximal oxygen consumption, p < 0.001).
- The refined criteria identified abnormal cardiac remodeling in 89% of severe aortic stenosis and 85% of HFpEF participants.
Conclusions:
- Current SBHF guideline criteria are non-specific and have limited clinical utility.
- Sex- and ethnic-specific thresholds can enhance the identification of individuals at risk for symptomatic heart failure.
- Further research is necessary to validate the proposed refined criteria for SBHF diagnosis.
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