Advancing Heart Ageing in Ischemic Heart Disease: Insights from CMR and ECG Analysis

AIMS: Ischemic heart disease (IHD) patients undergo cardiovascular alterations that can accelerate heart ageing. Estimating biological heart age using advanced cardiac magnetic resonance (CMR) and electrocardiogram (ECG)-derived phenotypes provides a biomarker for heart ageing. We investigated the relationship of IHD and heart ageing using biological age estimation biomarkers, and the contribution of conventional cardiac imaging indices and vascular risk factors (VRFs). METHODS AND RESULTS: Heart age was estimated in prevalent IHD cases (n = 2,142) incorporating CMR radiomics and ECG features. Heart age gap (HAG), representing the disparity between predicted and actual heart age, was calculated. IHD subjects had significantly higher heart age compared to those without the disease (HAG: 1.55 years ± 5.66; p <0.001). The main radiomics and ECG features linked to heart ageing in IHD delineated a phenotype of structural and electrical remodelling not typically seen in the ageing heart. Conventional CMR indices accounted for only a negligible fraction of the association between IHD and HAG. Among the VRFs, adiposity and hypertension were significantly associated with increasing HAG in IHD. CONCLUSION: Individuals with IHD showed higher estimated heart ageing than controls, consistent with greater deviation from normal heart ageing, and this was associated with selected VRFs. This relationship was only minimally explained by conventional CMR indices, suggesting that the heart age model captures additional imaging and electrical features beyond standard CMR measures. HAG may offer an exploratory framework for characterising phenotypic heterogeneity in IHD and contextualising cardiovascular risk; however, prospective validation is required prior to clinical application.