Grigorios Korosoglou1, Sorin Giusca2, Moritz Montenbruck3, Amit R Patel4, Tomas Lapinskas5, Collin Götze6, Victoria Zieschang6, Sarah Al-Tabatabaee6, Burkert Pieske6, Andre Florian7, Jennifer Erley6, Hugo A Katus7, Sebastian Kelle6, Henning Steen3. 1. Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany. Electronic address: gkorosoglou@hotmail.com. 2. Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany. 3. Department of Cardiology, Marien Hospital Hamburg, Hamburg, Germany. 4. Department of Medicine, University of Chicago, Chicago, Illinois, USA. 5. Department of Internal Medicine/Cardiology German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany; Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. 6. Department of Internal Medicine/Cardiology German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany. 7. Departments of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Germany.
Abstract
OBJECTIVES: The purpose of this study was to compare the ability of fast-strain encoded magnetic resonance (fast-SENC) cardiac magnetic resonance (CMR) to classify and risk stratify all-comer patients with different stages of chronic heart failure (Stages of heart failure A to D) based on American College of Cardiology/American Heart Association guidelines with standard clinical and CMR imaging data. BACKGROUND: Heart failure is a major cause of morbidity and mortality, resulting in millions of deaths and hospitalizations annually. METHODS: The study population consisted of 1,169 consecutive patients between September 2017 and February 2019 who underwent CMR for clinical reasons, and 61 healthy volunteers. In addition, clinical follow-up was performed in Stages A and B patients after 1.9 ± 0.4 years. Wall motion score and late gadolinium enhancement score indexes, left ventricular (LV) ejection fraction, and global circumferential and longitudinal strain based on fast-SENC acquisitions, were calculated in all subjects. The percentage of myocardial segments with strain ≤-17% (% normal myocardium) was determined in all subjects. RESULTS: LV ejection fraction, global circumferential and longitudinal strain, and % normal myocardium significantly decreased with increasing heart failure stages (p < 0.001 for all by analysis of variance). By multivariable analysis, % normal myocardium remained an independent predictor of heart failure stages, exhibiting closer association than LV ejection fraction (rpartial = 0.76 vs. rpartial = 0.30; p < 0.001). Importantly, 149 of 399 (37%) with Stage A were reclassified to Stage B, that is, as having subclinical LV dysfunction based on % normal myocardium <80%. Such patients exhibited significantly higher rates of all-cause mortality and hospital stay due to heart failure during follow-up, compared with patients with % normal myocardium ≥80% (chi-square = 6.9; p = 0.03). CONCLUSIONS: The % normal myocardium, determined by fast-SENC, enables improved identification of asymptomatic patients with subclinical LV dysfunction compared with LV ejection fraction and risk stratification of patients with so far asymptomatic heart failure. The identification of such presumably healthy patients at high risk for heart failure-related outcomes may bear important medical implications.
OBJECTIVES: The purpose of this study was to compare the ability of fast-strain encoded magnetic resonance (fast-SENC) cardiac magnetic resonance (CMR) to classify and risk stratify all-comer patients with different stages of chronic heart failure (Stages of heart failure A to D) based on American College of Cardiology/American Heart Association guidelines with standard clinical and CMR imaging data. BACKGROUND:Heart failure is a major cause of morbidity and mortality, resulting in millions of deaths and hospitalizations annually. METHODS: The study population consisted of 1,169 consecutive patients between September 2017 and February 2019 who underwent CMR for clinical reasons, and 61 healthy volunteers. In addition, clinical follow-up was performed in Stages A and B patients after 1.9 ± 0.4 years. Wall motion score and late gadolinium enhancement score indexes, left ventricular (LV) ejection fraction, and global circumferential and longitudinal strain based on fast-SENC acquisitions, were calculated in all subjects. The percentage of myocardial segments with strain ≤-17% (% normal myocardium) was determined in all subjects. RESULTS: LV ejection fraction, global circumferential and longitudinal strain, and % normal myocardium significantly decreased with increasing heart failure stages (p < 0.001 for all by analysis of variance). By multivariable analysis, % normal myocardium remained an independent predictor of heart failure stages, exhibiting closer association than LV ejection fraction (rpartial = 0.76 vs. rpartial = 0.30; p < 0.001). Importantly, 149 of 399 (37%) with Stage A were reclassified to Stage B, that is, as having subclinical LV dysfunction based on % normal myocardium <80%. Such patients exhibited significantly higher rates of all-cause mortality and hospital stay due to heart failure during follow-up, compared with patients with % normal myocardium ≥80% (chi-square = 6.9; p = 0.03). CONCLUSIONS: The % normal myocardium, determined by fast-SENC, enables improved identification of asymptomatic patients with subclinical LV dysfunction compared with LV ejection fraction and risk stratification of patients with so far asymptomatic heart failure. The identification of such presumably healthy patients at high risk for heart failure-related outcomes may bear important medical implications.
Authors: Jan Gröschel; Yashraj Bhoyroo; Edyta Blaszczyk; Ralf Felix Trauzeddel; Darian Viezzer; Hadil Saad; Maximilian Fenski; Jeanette Schulz-Menger Journal: Front Cardiovasc Med Date: 2022-07-14
Authors: Grigorios Korosoglou; Sorin Giusca; Florian André; Fabian Aus dem Siepen; Peter Nunninger; Arnt V Kristen; Norbert Frey Journal: Vasc Health Risk Manag Date: 2021-10-23