Chetan Shenoy1, Simone Romano2, Andrew Hughes3, Osama Okasha4, Prabhjot S Nijjar3, Pratik Velangi3, Cindy M Martin3, Mehmet Akçakaya5, Afshin Farzaneh-Far6. 1. Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota. Electronic address: cshenoy@umn.edu. 2. Department of Medicine, University of Verona, Verona, Italy. 3. Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota. 4. Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota; Department of Medicine, University of Missouri-Kansas City, Kansas City, Missouri. 5. Department of Electrical and Computer Engineering and Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota. 6. Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
Abstract
OBJECTIVES: This study determined the long-term prognostic significance of GLS assessed using CMR-FT in a large cohort of heart transplant recipients. BACKGROUND: In heart transplant recipients, global longitudinal strain (GLS) assessed using echocardiography has shown promise in the prediction of clinical outcomes. We hypothesized that CMR feature tracking (CMR-FT) GLS is independently associated with long-term outcomes in heart transplant recipients. METHODS: In a cohort of consecutive heart transplant recipients who underwent routine CMR for clinical surveillance, CMR-FT GLS was calculated from 3 long-axis cine CMR images. Associations between GLS and a composite endpoint of death or major adverse cardiac events (MACE), including retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization, were investigated. RESULTS: A total of 152 heart transplant recipients (age 54 ± 15 years; 29% women; 5.0 ± 5.4 years after heart transplantation) were included. The median GLS was -11.6% (interquartile range: -13.6% to -9.2%). Over a median follow-up of 2.6 years, 59 recipients reached the composite endpoint. On Kaplan-Meier analyses, recipients with GLS worse than the median had a higher estimated cumulative incidence of the composite endpoint compared with recipients with GLS better than the median (log rank p = 0.004). On multivariate Cox proportional hazards regression, GLS was independently associated with the composite endpoint after adjustment for cardiac allograft vasculopathy, history of rejection, left ventricular ejection fraction (LVEF), right ventricular EF, and presence of myocardial fibrosis, with a hazard ratio of 1.15 for every 1% worsening in GLS (95% confidence interval: 1.06 to 1.24; p < 0.001). Similar results were seen in subgroups of recipients with LVEF >50% and with no myocardial fibrosis. GLS provided incremental prognostic value over other variables in the multivariate model as determined by the log-likelihood chi-squared test. CONCLUSIONS: In a large cohort of heart transplant recipients, CMR-FT GLS was independently associated with the long-term risk of death or MACE.
OBJECTIVES: This study determined the long-term prognostic significance of GLS assessed using CMR-FT in a large cohort of heart transplant recipients. BACKGROUND: In heart transplant recipients, global longitudinal strain (GLS) assessed using echocardiography has shown promise in the prediction of clinical outcomes. We hypothesized that CMR feature tracking (CMR-FT) GLS is independently associated with long-term outcomes in heart transplant recipients. METHODS: In a cohort of consecutive heart transplant recipients who underwent routine CMR for clinical surveillance, CMR-FT GLS was calculated from 3 long-axis cine CMR images. Associations between GLS and a composite endpoint of death or major adverse cardiac events (MACE), including retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization, were investigated. RESULTS: A total of 152 heart transplant recipients (age 54 ± 15 years; 29% women; 5.0 ± 5.4 years after heart transplantation) were included. The median GLS was -11.6% (interquartile range: -13.6% to -9.2%). Over a median follow-up of 2.6 years, 59 recipients reached the composite endpoint. On Kaplan-Meier analyses, recipients with GLS worse than the median had a higher estimated cumulative incidence of the composite endpoint compared with recipients with GLS better than the median (log rank p = 0.004). On multivariate Cox proportional hazards regression, GLS was independently associated with the composite endpoint after adjustment for cardiac allograft vasculopathy, history of rejection, left ventricular ejection fraction (LVEF), right ventricular EF, and presence of myocardial fibrosis, with a hazard ratio of 1.15 for every 1% worsening in GLS (95% confidence interval: 1.06 to 1.24; p < 0.001). Similar results were seen in subgroups of recipients with LVEF >50% and with no myocardial fibrosis. GLS provided incremental prognostic value over other variables in the multivariate model as determined by the log-likelihood chi-squared test. CONCLUSIONS: In a large cohort of heart transplant recipients, CMR-FT GLS was independently associated with the long-term risk of death or MACE.
Authors: C Sciaccaluga; G E Mandoli; N Sisti; M B Natali; A Ibrahim; D Menci; A D'Errico; G Donati; G Benfari; S Valente; S Bernazzali; M Maccherini; S Mondillo; M Cameli; M Focardi Journal: Int J Cardiovasc Imaging Date: 2021-01-13 Impact factor: 2.357
Authors: Daming Shen; Ashitha Pathrose; Roberto Sarnari; Allison Blake; Haben Berhane; Justin J Baraboo; James C Carr; Michael Markl; Daniel Kim Journal: NMR Biomed Date: 2021-09-02 Impact factor: 4.044
Authors: Andreas Ochs; Johannes Riffel; Marco M Ochs; Nisha Arenja; Thomas Fritz; Christian Galuschky; Andreas Schuster; Oliver Bruder; Heiko Mahrholdt; Evangelos Giannitsis; Norbert Frey; Hugo A Katus; Sebastian J Buss; Florian André Journal: J Cardiovasc Magn Reson Date: 2021-12-02 Impact factor: 5.364