Jose Gavara1, Jose F Rodriguez-Palomares2, Filipa Valente2, Jose V Monmeneu3, Maria P Lopez-Lereu3, Clara Bonanad1, Ignacio Ferreira-Gonzalez4, Bruno Garcia Del Blanco2, Julian Rodriguez-Garcia2, Maria Mutuberria2, Elena de Dios1, Cesar Rios-Navarro1, Nerea Perez-Sole1, Paolo Racugno1, Ana Paya1, Gema Minana1, Joaquim Canoves5, Mauricio Pellicer1, Francisco J Lopez-Fornas1, Jose Barrabes2, Arturo Evangelista2, Julio Nunez1, Francisco J Chorro5, David Garcia-Dorado6, Vicente Bodi7. 1. Department of Cardiology, Hospital Clinico Universitario, INCLIVA, University of Valencia, Valencia, Spain. 2. Hospital Universitari Vall d'Hebron, Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain. 3. Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain. 4. Hospital Universitari Vall d'Hebron, Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red-ESP, Madrid, Spain. 5. Department of Cardiology, Hospital Clinico Universitario, INCLIVA, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red-CV, Madrid, Spain. 6. Hospital Universitari Vall d'Hebron, Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red-CV, Madrid, Spain. Electronic address: dgdorado@vhebron.net. 7. Department of Cardiology, Hospital Clinico Universitario, INCLIVA, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red-CV, Madrid, Spain. Electronic address: vicente.bodi@uv.es.
Abstract
OBJECTIVES: The aim of this study was to evaluate the prognostic value of strain as assessed by tissue tracking (TT) cardiac magnetic resonance (CMR) soon after ST-segment elevation myocardial infarction (STEMI). BACKGROUND: The prognostic value of myocardial strain as assessed post-STEMI by TT-CMR is unknown. METHODS: The authors studied the prognostic value of TT-CMR in 323 patients who underwent CMR 1 week post-STEMI. Global (average of peak segmental values [%]) and segmental (number of altered segments) longitudinal (LS), circumferential, and radial strain were assessed using TT-CMR. Global and segmental strain cutoff values were derived from 32 control patients. CMR-derived left ventricular ejection fraction, microvascular obstruction, and infarct size were determined. Results were validated in an external cohort of 190 STEMI patients. RESULTS: During a median follow-up of 1,085 days, 54 first major adverse cardiac events (MACE), which included 10 cardiac deaths, 25 readmissions for heart failure, and 19 readmissions for reinfarction were documented. MACE was associated with more severe abnormalities in all strain indexes (p < 0.001), although only global LS was an independent predictor (p < 0.001). The MACE rate was higher in patients with a global LS of ≥-11% (22% vs. 9%; p = 0.001). After adjustment for baseline and CMR variables, global LS (hazard ratio [HR]: 1.21; 95% confidence interval [CI]: 1.11 to 1.32; p < 0.001) was associated with MACE. In the external validation cohort, a global LS ≥-11% was seen in a higher proportion of patients with MACE (34% vs. 9%; p < 0.001). Global LS predicted MACE after adjustment for baseline and CMR variables (HR: 1.18; 95% CI: 1.04 to 1.33; p = 0.008). The addition of global LS to the multivariate models, including baseline and CMR variables, did not significantly improve the categorical net reclassification improvement index in either the study group (-0.015; p = 0.7) or in the external validation cohort (-0.019; p = 0.9). CONCLUSIONS: TT-CMR provided prognostic information soon after STEMI. However, it did not substantially improve risk reclassification beyond traditional CMR indexes.
OBJECTIVES: The aim of this study was to evaluate the prognostic value of strain as assessed by tissue tracking (TT) cardiac magnetic resonance (CMR) soon after ST-segment elevation myocardial infarction (STEMI). BACKGROUND: The prognostic value of myocardial strain as assessed post-STEMI by TT-CMR is unknown. METHODS: The authors studied the prognostic value of TT-CMR in 323 patients who underwent CMR 1 week post-STEMI. Global (average of peak segmental values [%]) and segmental (number of altered segments) longitudinal (LS), circumferential, and radial strain were assessed using TT-CMR. Global and segmental strain cutoff values were derived from 32 control patients. CMR-derived left ventricular ejection fraction, microvascular obstruction, and infarct size were determined. Results were validated in an external cohort of 190 STEMI patients. RESULTS: During a median follow-up of 1,085 days, 54 first major adverse cardiac events (MACE), which included 10 cardiac deaths, 25 readmissions for heart failure, and 19 readmissions for reinfarction were documented. MACE was associated with more severe abnormalities in all strain indexes (p < 0.001), although only global LS was an independent predictor (p < 0.001). The MACE rate was higher in patients with a global LS of ≥-11% (22% vs. 9%; p = 0.001). After adjustment for baseline and CMR variables, global LS (hazard ratio [HR]: 1.21; 95% confidence interval [CI]: 1.11 to 1.32; p < 0.001) was associated with MACE. In the external validation cohort, a global LS ≥-11% was seen in a higher proportion of patients with MACE (34% vs. 9%; p < 0.001). Global LS predicted MACE after adjustment for baseline and CMR variables (HR: 1.18; 95% CI: 1.04 to 1.33; p = 0.008). The addition of global LS to the multivariate models, including baseline and CMR variables, did not significantly improve the categorical net reclassification improvement index in either the study group (-0.015; p = 0.7) or in the external validation cohort (-0.019; p = 0.9). CONCLUSIONS: TT-CMR provided prognostic information soon after STEMI. However, it did not substantially improve risk reclassification beyond traditional CMR indexes.
Authors: Martin Reindl; Christina Tiller; Magdalena Holzknecht; Ivan Lechner; Dorothea Eisner; Laura Riepl; Mathias Pamminger; Benjamin Henninger; Agnes Mayr; Johannes P Schwaiger; Gert Klug; Axel Bauer; Bernhard Metzler; Sebastian J Reinstadler Journal: Clin Res Cardiol Date: 2020-04-15 Impact factor: 5.460
Authors: Simone Romano; Robert M Judd; Raymond J Kim; John F Heitner; Dipan J Shah; Chetan Shenoy; Kaleigh Evans; Benjamin Romer; Pablo Salazar; Afshin Farzaneh-Far Journal: JACC Cardiovasc Imaging Date: 2019-11-11
Authors: Nicholas B Spath; Miquel Gomez; Russell J Everett; Scott Semple; Calvin W L Chin; Audrey C White; Alan G Japp; David E Newby; Marc R Dweck Journal: Radiol Cardiothorac Imaging Date: 2019-10-31