Association of cardiovascular magnetic resonance-derived circumferential strain parameters with the risk of ventricular arrhythmia and all-cause mortality in patients with prior myocardial infarction and primary prevention implantable cardioverter defibrillator

Abstract

Background Impaired left ventricular (LV) contraction and relaxation may further promote adverse remodeling and may increase the risk of ventricular arrhythmia (VA) in ischemic cardiomyopathy. We aimed to examine the association of cardiovascular magnetic resonance (CMR)-derived circumferential strain parameters for LV regional systolic function, LV diastolic function and mechanical dispersion with the risk of VA in patients with prior myocardial infarction and primary prevention implantable cardioverter defibrillator (ICD). Methods Patients with an ischemic cardiomyopathy who underwent CMR prior to primary prevention ICD implantation, were retrospectively identified. LV segmental circumferential strain curves were extracted from short-axis cine CMR. For LV regional strain analysis, the extent of moderately and severely impaired strain (percentage of LV segments with strain between − 10% and − 5% and > − 5%, respectively) were calculated. LV diastolic function was quantified by the early and late diastolic strain rate. Mechanical dispersion was defined as the standard deviation in delay time between each strain curve and the patient-specific reference curve. Cox proportional hazard ratios (HR) (95%CI) were calculated to assess the association between LV strain parameters and appropriate ICD therapy. Results A total of 121 patients (63 ± 11 years, 84% men, LV ejection fraction (LVEF) 27 ± 9%) were included. During a median (interquartile range) follow-up of 47 (27;69) months, 30 (25%) patients received appropriate ICD therapy. The late diastolic strain rate (HR 1.1 (1.0;1.2) per − 0.25 1/s, P = 0.043) and the extent of moderately impaired strain (HR 1.5 (1.0;2.2) per + 10%, P = 0.048) but not the extent of severely impaired strain (HR 0.9 (0.6;1.4) per + 10%, P = 0.685) were associated with appropriate ICD therapy, independent of LVEF, late gadolinium enhancement (LGE) scar border size and acute revascularization. Mechanical dispersion was not related to appropriate ICD therapy (HR 1.1 (0.8;1.6) per + 25 ms, P = 0.464). Conclusions In an ischemic cardiomyopathy population referred for primary prevention ICD implantation, the extent of moderately impaired strain and late diastolic strain rate were associated with the risk of appropriate ICD therapy, independent of LVEF, scar border size and acute revascularization. These findings suggest that disturbed LV contraction and relaxation may contribute to an increased risk of VA after myocardial infarction. Electronic supplementary material The online version of this article (10.1186/s12968-019-0536-5) contains supplementary material, which is available to authorized users.

Prognostic Value of Cardiac‐MRI Scar Heterogeneity Combined With Left Ventricular Strain in Patients With Myocardial Infarction

“…For other factors, LVEF, percentage of BZ mass, percentage of IC mass, percentage of IBZ mass, IC entropy, IBZ entropy, and GLS were correlated with SCD and dangerous VA, similar to other post‐MI research 19 . Whereas GCS was not a statistical prognostic parameter in our study and different from Elisabeth's research 36 . The trial involved 121 post‐MI patients referred for primary prevention ICD implantation and found circumferential strain parameters were associated with appropriate ICD therapy, after adjusting for the effects of LVEF and BZ mass% 36 .…”

“…19 Whereas GCS was not a statistical prognostic parameter in our study and different from Elisabeth's research. 36 The trial involved 121 post-MI patients referred for primary prevention ICD implantation and found circumferential strain parameters were associated with appropriate ICD therapy, after adjusting for the effects of LVEF and BZ mass%. 36 Choosing different endpoint events, the inclusion of radial and longitudinal strain parameters can explain the inconsistency.…”

“…36 The trial involved 121 post-MI patients referred for primary prevention ICD implantation and found circumferential strain parameters were associated with appropriate ICD therapy, after adjusting for the effects of LVEF and BZ mass%. 36 Choosing different endpoint events, the inclusion of radial and longitudinal strain parameters can explain the inconsistency. SII and other clinical laboratory indicators were not statistical factors either, which is different from previous studies.…”

Myocardial strain assessment using cardiovascular magnetic resonance imaging in recipients of implantable cardioverter defibrillators

“…Mordi et al found GCS derived by harmonic phase myocardial tagging to be independently prognostic in their single-centre study of 539 unselected patients undergoing CMR after adjusting for LVEF and LGE [ 32 ]. Paiman et al found the extent of moderately impaired LV GCS to be associated with appropriate ICD therapy in 121 patients with primary prevention ICDs and history of previous myocardial infarction [ 33 ]. However, this original study was relatively small with only 30 events and, the endpoint of appropriate ICD therapy included ATP in addition to shocks.…”

Quantification of Myocardial Deformation Applying CMR-Feature-Tracking—All About the Left Ventricle?

“…In this way, a simplified deformation analysis with high reproducibility is possible [41] and analyses even without dedicated post processing software are conceivable. Importantly, by predicting ventricular arrhythmia or early myocardial remodelling very accurately [42,43], CMR-FT-based LV strain was found to outperform traditionally used LVEF in these studies further questioning current approaches using a LVEF cut of 35% for defibrillator device therapy and raising considerations of new risk classifications beyond this parameter. Of note, not only global LV strain analyses but also regional CMR-derived strain evaluations of non-infarcted remote myocardium were shown to allow an extended risk classification and categorise new high-risk groups in patients suffering AMI [44].…”