Prognostic Utility of Cardiac MRI Myocardial Strain Parameters in Patients With Ischemic and Nonischemic Dilated Cardiomyopathy: A Multicenter Study

Tang, Hok Shing; Kwan, Chi Ting; He, Jianlong; Ng, Pan Pan; Hai, Siu Han Jojo; Kwok, Fung Yu James; Sze, Ho Fung; So, Man Hon; Lo, Hong Yip; Fong, Ho Tung Ambrose; Wan, Eric Yuk Fai; Lee, Chi H.; Yu, Esther Yee Tak; Lai, Yee Tak Alta; Lee, Chun Yin Jonan; Leung, Siu Ting; Chan, Hiu Lam; Tse, Hung Fat; Pennell, Dudley J; Mohiaddin, Raad H.; Senior, Roxy; Yan, Andrew T.; Yiu, Kai‐Hang; Ng, Ming-Yen

doi:10.2214/ajr.22.28415

Cited by 6 publications

(4 citation statements)

References 30 publications

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“…previous studies investigated the role of feature tracking imaging (FTI) for the risk strati cation of patients with ischemic and non-ischemic heart disease. [32][33][34][35][36] In this regards, FTI derived GLS exhibited incremental value to CMR variables such as LV-ejection fraction and late gadolinium enhancement (LGE) for the prediction of MACE, including sudden cardiac death, resuscitated cardiac arrest and hospitalization due to heart failure in patients with hypertrophic cardiomyopathy. 32 In addition, LV strain parameters were independent predictors of MACE beyond clinical and conventional CMR markers, such as LVEF and LGE, in 162 patients with acute myocarditis, analyzed within a multi-center trial, while left atrial and right ventricular strain were less useful in this context.…”

Section: Discussionmentioning

confidence: 99%

“…34 This could be con rmed in recent multi-center CMR studies, where FTI derived strain parameters surpassed the value of conventional functional CMR parameters, thus strengthening the body of evidence for the clinical implementation of strain for the risk strati cation of patients with non-ischemic heart diseases. 35,36 Fewer studies, however, have investigated the value of FTI for the diagnostic classi cation or risk strati cation of patients ischemic heart disease. 37,38 From a technical point of view FTI is based on pattern matching techniques across multiple images in a cardiac cycle.…”

Section: Discussionmentioning

confidence: 99%

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Cardiac Magnetic Resonance Strain for the Prediction of Cardiac Outcomes. Systematic Review and Meta-analysis Based on Individual Patient Data.

Korosoglou,

Sagris,

André

et al. 2023

Preprint

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BACKGROUND.Cardiac magnetic resonance (CMR) is the gold standard for the diagnostic classification and risk stratification in most patients with cardiac disorders. PURPOSE/HYPOTHESIS.To investigate the ability of Strain-encoded MR (SENC) for the prediction of major adverse cardiovascular events (MACE). STUDY TYPE Systematic review and meta-analysis according to the PRISMA Guidelines. POPULATION.Patients with or without cardiovascular disease and asymptomatic individuals. FIELD STRENGTH/SEQUENCE Myocardial strain by HARP in 1.5T scanners. ASSESSMENT.Published literature in MEDLINE (PubMed) and Cochrane’s databases were explored before February 2023 for studies assessing the clinical utility of myocardial strain by Harmonic Phase Magnetic Resonance Imaging (HARP), Strain-encoded MR (SENC) or fast-SENC. In total, 8 clinical trials (4 studies conducted in asymptomatic individuals and 4 in patients with suspected or known cardiac disease) were included in this systematic review, while 3 studies were used for our meta-analysis, based on individual patient level data. STATISTICAL TESTS. Kaplan-Meier analysis and Cox proportional hazard models were used, testing the ability of myocardial strain by HARP and SENC/fast-SENC for the prediction of MACE. RESULTS Strain enabled risk stratification in asymptomatic individuals, predicting MACE and the development of incident heart failure. Of 1,332 patients who underwent clinically indicated CMR, including SENC or fast-SENC acquisitions, 19 patients died, 28 experienced non-fatal infarctions, 52 underwent coronary revascularization and 86 were hospitalized due to heart failure during 22.4(17.2-28.5) months of follow-up. SENC/fast-SENC, predicted both all-cause mortality and MACE with high accuracy (HR=3.0, (95%CI=1.2-7.6), p=0.02 and HR=4.1, 95%CI=3.0-5.5, respectively, p<0.001). Using hierarchical cox-proportional hazard regression models, SENC/fast-SENC exhibited incremental value to clinical data and conventional CMR markers. DATA CONCLUSION. Reduced myocardial strain predicts of all-cause mortality and cardiac outcomes in symptomatic patients with a wide range of ischemic or non-ischemic cardiac diseases, whereas in asymptomatic individuals, reduced strain is a precursor of incident heart failure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cardiac Magnetic Resonance Strain for the Prediction of Cardiac Outcomes. Systematic Review and Meta-analysis Based on Individual Patient Data.

Korosoglou,

Sagris,

André

et al. 2023

Preprint

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“…As one of the most prevalent cardiomyopathies worldwide with structural and functional abnormalities, DCM often leads to higher mortality [18][19][20] and there is no effective treatment to prevent the progression of DCM. Ferroptosis is a novel type of regulated cell death triggered by iron-dependent lipid peroxidation, which is involved in a variety of cardiovascular diseases.…”

Section: Discussionmentioning

confidence: 99%

“…14 However, there is no effective treatment for heterogeneous DCM patients, and the majority of DCM patients have poor outcomes and prognosis. [18][19][20] Moreover, the mechanism of heterogeneity in DCM patients remains uncertain. Therefore, there is an urgent need to explore the mechanism of heterogeneity in DCM patients and to identify potential targets.…”

Section: Discussionmentioning

confidence: 99%

Identification of Novel Targets for Treatment of Dilated Cardiomyopathy Based on the Ferroptosis and Immune Heterogeneity

Lu¹,

Xie²,

Zhou³

et al. 2023

JIR

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Purpose This study aimed to investigate the role of ferroptosis in dilated cardiomyopathy (DCM) and to identify new targets for treatment and diagnosis of DCM. Methods GSE116250 and GSE145154 were downloaded from the Gene Expression Omnibus database. Unsupervised consensus clustering of DCM patients was used to confirm the impact of ferroptosis. Ferroptosis-related hub genes were identified by WGCNA and single cell sequencing analyses. Finally, we established a DCM mouse model via injection of Doxorubicin to verify the expression level of OTUD1 and colocalization between cell markers and OTUD1 in DCM mouse heart. Results A total of 13 ferroptosis-related differentially expressed genes (DEGs) were identified. The DCM patients were divided into two clusters according to the expression of 13 DEGs. The DCM patients in different clusters showed discrepancies in immune infiltration. Four hub genes were further identified by WGCNA analysis. Single cell data analysis revealed that OTUD1 may regulate B cells and DC cells and then participate in immune infiltration discrepancy. The upregulation of OTUD1 and the colocalization of OTUD1 with CD19 (B cell maker) and CD11c (DCs markers) markers were confirmed in DCM mouse hearts. Conclusion Ferroptosis and the immune microenvironment are closely associated with DCM, and OTUD1 may play an important role through B cells and DCs.

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Risk Stratification in Nonischemic Dilated Cardiomyopathy Using CMR Imaging

Eichhorn,

Koeckerling,

Reddy

et al. 2024

JAMA

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ImportanceAccurate risk stratification of nonischemic dilated cardiomyopathy (NIDCM) remains challenging.ObjectiveTo evaluate the association of cardiac magnetic resonance (CMR) imaging–derived measurements with clinical outcomes in NIDCM.Data SourcesMEDLINE, Embase, Cochrane Library, and Web of Science Core Collection databases were systematically searched for articles from January 2005 to April 2023.Study SelectionProspective and retrospective nonrandomized diagnostic studies reporting on the association between CMR imaging–derived measurements and adverse clinical outcomes in NIDCM were deemed eligible.Data Extraction and SynthesisPrespecified items related to patient population, CMR imaging measurements, and clinical outcomes were extracted at the study level by 2 independent reviewers. Random-effects models were fitted using restricted maximum likelihood estimation and the method of Hartung, Knapp, Sidik, and Jonkman.Main Outcomes and MeasuresAll-cause mortality, cardiovascular mortality, arrhythmic events, heart failure events, and major adverse cardiac events (MACE).ResultsA total of 103 studies including 29 687 patients with NIDCM were analyzed. Late gadolinium enhancement (LGE) presence and extent (per 1%) were associated with higher all-cause mortality (hazard ratio [HR], 1.81 [95% CI, 1.60-2.04]; P &lt; .001 and HR, 1.07 [95% CI, 1.02-1.12]; P = .02, respectively), cardiovascular mortality (HR, 2.43 [95% CI, 2.13-2.78]; P &lt; .001 and HR, 1.15 [95% CI, 1.07-1.24]; P = .01), arrhythmic events (HR, 2.69 [95% CI, 2.20-3.30]; P &lt; .001 and HR, 1.07 [95% CI, 1.03-1.12]; P = .004) and heart failure events (HR, 1.98 [95% CI, 1.73-2.27]; P &lt; .001 and HR, 1.06 [95% CI, 1.01-1.10]; P = .02). Left ventricular ejection fraction (LVEF) (per 1%) was not associated with all-cause mortality (HR, 0.99 [95% CI, 0.97-1.02]; P = .47), cardiovascular mortality (HR, 0.97 [95% CI, 0.94-1.00]; P = .05), or arrhythmic outcomes (HR, 0.99 [95% CI, 0.97-1.01]; P = .34). Lower risks for heart failure events (HR, 0.97 [95% CI, 0.95-0.98]; P = .002) and MACE (HR, 0.98 [95% CI, 0.96-0.99]; P &lt; .001) were observed with higher LVEF. Higher native T1 relaxation times (per 10 ms) were associated with arrhythmic events (HR, 1.07 [95% CI, 1.01-1.14]; P = .04) and MACE (HR, 1.06 [95% CI, 1.01-1.11]; P = .03). Global longitudinal strain (GLS) (per 1%) was not associated with heart failure events (HR, 1.06 [95% CI, 0.95-1.18]; P = .15) or MACE (HR, 1.03 [95% CI, 0.94-1.14]; P = .43). Limited data precluded definitive analysis for native T1 relaxation times, GLS, and extracellular volume fraction (ECV) with respect to mortality outcomes.ConclusionThe presence and extent of LGE were associated with various adverse clinical outcomes, whereas LVEF was not significantly associated with mortality and arrhythmic end points in NIDCM. Risk stratification using native T1 relaxation times, extracellular volume fraction, and global longitudinal strain requires further evaluation.

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Prognostic Utility of Cardiac MRI Myocardial Strain Parameters in Patients With Ischemic and Nonischemic Dilated Cardiomyopathy: A Multicenter Study

Cited by 6 publications

References 30 publications

Cardiac Magnetic Resonance Strain for the Prediction of Cardiac Outcomes. Systematic Review and Meta-analysis Based on Individual Patient Data.

Cardiac Magnetic Resonance Strain for the Prediction of Cardiac Outcomes. Systematic Review and Meta-analysis Based on Individual Patient Data.

Identification of Novel Targets for Treatment of Dilated Cardiomyopathy Based on the Ferroptosis and Immune Heterogeneity

Risk Stratification in Nonischemic Dilated Cardiomyopathy Using CMR Imaging

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