Fast manual long-axis strain assessment provides optimized cardiovascular event prediction following myocardial infarction.

Abstract

AIMS:

Cardiovascular magnetic resonance feature tracking (CMR-FT) global longitudinal strain (GLS) provides incremental prognostic value following acute myocardial infarction (AMI) but requires substantial post-processing. Alternatively, manual global long-axis strain (LAS) can be easily assessed from standard steady state free precession images. We aimed to define the prognostic value of LAS in a large multicentre study in patients following AMI.

METHODS AND RESULTS:

A total of 1235 patients with myocardial infarction [n = 795 with ST-elevation myocardial infarction (STEMI) and 440 with non-ST-elevation myocardial infarction (NSTEMI)] underwent cardiovascular magnetic resonance imaging after primary percutaneous coronary intervention in eight centres across Germany. Assessment of LAS was performed in a blinded core-laboratory measuring the systolic shortening between the epicardial apical border and the middle of a line connecting the origins of the mitral leaflets. Primary clinical endpoint was the occurrence of major adverse clinical events (MACE) including death, reinfarction, and congestive heart failure within 1 year after AMI. During 1-year follow-up, 76 patients suffered from MACE. Impaired LAS was associated with higher MACE occurrence both in STEMI (P < 0.001) and NSTEMI (P = 0.001) patients. Association of LAS remained significant (P = 0.017) after correction for univariate significant parameters for MACE prediction. C-statistics revealed incremental value of additional LAS assessment for optimized event prediction compared with left ventricular ejection fraction (MACE P = 0.044; mortality P = 0.013) and a combination of established clinical and imaging parameters (MACE P = 0.084; mortality P = 0.027), but not CMR-FT GLS (MACE P = 0.075; mortality P = 0.380).

CONCLUSION:

LAS provides software independent, widely available, easy and fast approximation of longitudinal left ventricular shortening early after reperfused AMI with incremental prognostic value beyond established risk stratification parameters.

CLINICAL TRIALS.GOV:

NCT00712101 and NCT01612312.

• Authors: Andreas Schuster, Sören J Backhaus, Thomas Stiermaier, Johannes T Kowallick, Alina Stulle, Alexander Koschalka, Joachim Lotz, Shelby Kutty, Boris Bigalke, Matthias Gutberlet, Gerd Hasenfuß, Holger Thiele, Ingo Eitel
• Journal: European heart journal. Cardiovascular Imaging (Eur Heart J Cardiovasc Imaging) Vol. 20 Issue 11 Pg. 1262-1270 (Nov 01 2019) ISSN: 2047-2412 [Electronic] England
• PMID: 31329854 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: [email protected].

Chemical References

• Contrast Media

Topics

• Aged
• Contrast Media
• Female
• Germany
• Humans
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Myocardial Infarction (diagnostic imaging, physiopathology, therapy)
• Prognosis
• Randomized Controlled Trials as Topic
• Risk Assessment
• Risk Factors
• Ventricular Dysfunction, Left (diagnostic imaging, physiopathology, therapy)