Prediction of cardiac events with non‐contrast magnetic resonance feature tracking in patients with ischaemic cardiomyopathy

Abstract

Aims The aim of this study was to evaluate the prognostic value of feature tracking (FT) derived cardiac magnetic resonance (CMR) strain parameters of the left ventricle (LV)/right ventricle (RV) in ischaemic cardiomyopathy (ICM) patients treated with an implantable cardioverter‐defibrillator (ICD). Current guidelines suggest a LV‐ejection fraction ≤35% as major criterion for ICD implantation in ICM, but this is a poor predictor for arrhythmic events. Supplementary parameters are missing. Methods and results Ischaemic cardiomyopathy patients (n = 242), who underwent CMR imaging prior to primary and secondary implantation of ICD, were classified depending on EF ≤ 35% (n = 188) or >35% (n = 54). FT parameters were derived from steady‐state free precession cine views using dedicated software. The primary endpoint was a composite of cardiovascular mortality (CVM) and/or appropriate ICD therapy. There were no significant differences in FT‐function or LV‐/RV‐function parameters in patients with an EF ≤ 35% correlating to the primary endpoint. In patients with EF > 35%, standard CMR functional parameters, such as LV‐EF, did not reveal significant differences. However, significant differences in most FT parameters correlating to the primary endpoint were observed in this subgroup. LV‐GLS (left ventricular‐global longitudinal strain) and RV‐GRS (right ventricular‐global radial strain) revealed the best diagnostic performance in ROC curve analysis. The combination of LV‐GLS and RV‐GRS showed a sensitivity of 85% and a specificity of 76% for the prediction of future events. Conclusions The impact of FT derived measurements in the risk stratification of patients with ICM depends on LV function. The combination of LV‐GLS/RV‐GRS seems to be a predictor of cardiovascular mortality and/or appropriate ICD therapy in patients with EF > 35%.

Recent Non-Invasive Parameters to Identify Subjects at High Risk of Sudden Cardiac Death

“…One recent study revealed that measurements of LV GLS and RV-global radial strain can be used to predict outcomes in patients diagnosed with ischemic cardiomyopathy with an LVEF > 35%. This information might assist with decision making regarding ICD use in patients with ischemic cardiomyopathy with a mild or moderately reduced EF [ 92 ].…”

The Combination of Feature Tracking and Late Gadolinium Enhancement for Identification Between Hypertrophic Cardiomyopathy and Hypertensive Heart Disease

“…Cardiovascular magnetic resonance feature tracking (CMR-FT) technology allows for high-resolution evaluation of myocardial deformation and the determination of myocardial strain parameters with excellent consistency and reproducibility ( 8 – 10 ). It tracks tissue motion between epicardial and endocardial borders and measures changes of cardiac dimensions throughout the whole cardiac cycle, thus potentially distinguishing the normal and abnormal cardiac functions ( 11 ). Global longitudinal strain (GLS) was significantly higher in the HCM group than in the HHD group and the circumferential strain difference between the endocardium and epicardium has been shown to identify preclinical and overt HCM ( 8 , 12 ).…”

Diagnostic accuracy of Left atrial function and strain for differentiating between acute and chronic myocardial infarction

“…[4] . CMR-TT can detect early distortion of the left ventricle and atrium without the use of contrast [5] . It has a higher spatial resolution, a bigger eld of view, and better consistency than speckle-tracking echocardiography (STE), and it can more accurately depict the functional features of cardiac tissue [6] .…”