Torben Lange1, Thomas Stiermaier2,3, Ingo Eitel2,3, Sören J Backhaus1, Patricia C Boom1, Johannes T Kowallick4, Suzanne de Waha-Thiele2,3, Joachim Lotz4, Shelby Kutty5, Boris Bigalke6, Matthias Gutberlet7, Hans-Josef Feistritzer8, Steffen Desch8, Gerd Hasenfuß1, Holger Thiele8, Andreas Schuster9. 1. Department of Cardiology and Pneumology, Göttingen Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, Göttingen, Germany. 2. University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany. 3. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany. 4. Institute for Diagnostic and Interventional Radiology, Göttingen Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, University Medical Center Göttingen, Georg-August University, Göttingen, Germany. 5. Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA. 6. Department of Cardiology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Berlin, Germany. 7. Institute of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany. 8. Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany. 9. Department of Cardiology and Pneumology, Göttingen Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, Göttingen, Germany. andreas.schuster@med.uni-goettingen.de.
Abstract
BACKGROUND: Cardiac magnetic resonance myocardial feature tracking (CMR-FT)-derived global strain assessments provide incremental prognostic information in patients following acute myocardial infarction (AMI). Functional analyses of the remote myocardium (RM) are scarce and whether they provide an additional prognostic value in these patients is unknown. METHODS: 1034 patients following acute myocardial infarction were included. CMR imaging and strain analyses as well as infarct size quantification were performed after reperfusion by primary percutaneous coronary intervention. The occurrence of major adverse cardiac events (MACE) within 12 months after the index event was defined as primary clinical endpoint. RESULTS: Patients with MACE had significantly lower RM circumferential strain (CS) compared to those without MACE. A cutoff value for RM CS of - 25.8% best identified high-risk patients (p < 0.001 on log-rank testing) and impaired RM CS was a strong predictor of MACE (HR 1.05, 95% CI 1.07-1.14, p = 0.003). RM CS provided further risk stratification among patients considered at risk according to established CMR parameters for (1) patients with reduced left ventricular ejection fraction (LVEF) ≤ 35% (p = 0.038 on log-rank testing), (2) patients with reduced global circumferential strain (GCS) > - 18.3% (p = 0.015 on log-rank testing), and (3) patients with large microvascular obstruction ≥ 1.46% (p = 0.002 on log-rank testing). CONCLUSION: CMR-FT-derived RM CS is a useful parameter to characterize the response of the remote myocardium and allows improved stratification following AMI beyond commonly used parameters, especially of high-risk patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00712101 and NCT01612312 Defining remote segments (R) in the presence of infarct areas (I) for the analysis of remote circumferential strain (CS). Remote CS was significantly lower in patients who suffered major adverse cardiac events (MACE) and a cutoff value for remote CS of - 25.8% best identified high-risk patients. In addition, impaired remote CS ≥ - 25.8 % (Remote -) and preserved remote CS < - 25.8 % (Remote +) enabled further risk stratification when added to established parameters like left ventricular ejection fraction (LVEF), global circumferential strain (GCS) or microvascular obstruction (MVO).
BACKGROUND: Cardiac magnetic resonance myocardial feature tracking (CMR-FT)-derived global strain assessments provide incremental prognostic information in patients following acute myocardial infarction (AMI). Functional analyses of the remote myocardium (RM) are scarce and whether they provide an additional prognostic value in these patientsis unknown. METHODS: 1034 patients following acute myocardial infarction were included. CMR imaging and strain analyses as well as infarct size quantification were performed after reperfusion by primary percutaneous coronary intervention. The occurrence of major adverse cardiac events (MACE) within 12 months after the index event was defined as primary clinical endpoint. RESULTS:Patients with MACE had significantly lower RM circumferential strain (CS) compared to those without MACE. A cutoff value for RM CS of - 25.8% best identified high-risk patients (p < 0.001 on log-rank testing) and impaired RM CS was a strong predictor of MACE (HR 1.05, 95% CI 1.07-1.14, p = 0.003). RM CS provided further risk stratification among patients considered at risk according to established CMR parameters for (1) patients with reduced left ventricular ejection fraction (LVEF) ≤ 35% (p = 0.038 on log-rank testing), (2) patients with reduced global circumferential strain (GCS) > - 18.3% (p = 0.015 on log-rank testing), and (3) patients with large microvascular obstruction ≥ 1.46% (p = 0.002 on log-rank testing). CONCLUSION: CMR-FT-derived RM CSis a useful parameter to characterize the response of the remote myocardium and allows improved stratification following AMI beyond commonly used parameters, especially of high-risk patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00712101 and NCT01612312 Defining remote segments (R) in the presence of infarct areas (I) for the analysis of remote circumferential strain (CS). Remote CS was significantly lower in patients who suffered major adverse cardiac events (MACE) and a cutoff value for remote CS of - 25.8% best identified high-risk patients. In addition, impaired remote CS ≥ - 25.8 % (Remote -) and preserved remote CS < - 25.8 % (Remote +) enabled further risk stratification when added to established parameters like left ventricular ejection fraction (LVEF), global circumferential strain (GCS) or microvascular obstruction (MVO).
Authors: Sören J Backhaus; Georg Metschies; Victoria Zieschang; Jennifer Erley; Seyedeh Mahsa Zamani; Johannes T Kowallick; Tomas Lapinskas; Burkert Pieske; Joachim Lotz; Shelby Kutty; Gerd Hasenfuß; Sebastian Kelle; Andreas Schuster Journal: Magn Reson Med Date: 2020-08-27 Impact factor: 4.668
Authors: Daniel M O'Connor; Robert S Smith; Bryan A Piras; Ronald J Beyers; Dan Lin; John A Hossack; Brent A French Journal: J Am Heart Assoc Date: 2016-04-22 Impact factor: 5.501
Authors: Andreas Schuster; Torben Lange; Sören J Backhaus; Carolin Strohmeyer; Patricia C Boom; Jonas Matz; Johannes T Kowallick; Joachim Lotz; Michael Steinmetz; Shelby Kutty; Boris Bigalke; Matthias Gutberlet; Suzanne de Waha-Thiele; Steffen Desch; Gerd Hasenfuß; Holger Thiele; Thomas Stiermaier; Ingo Eitel Journal: J Am Heart Assoc Date: 2020-09-02 Impact factor: 5.501
Authors: Ruben Evertz; Alexander Schulz; Torben Lange; Sören J Backhaus; Dirk Vollmann; Johannes T Kowallick; Stephan von Haehling; Gerd Hasenfuß; Andreas Schuster Journal: Front Cardiovasc Med Date: 2022-08-23