Prognostic value of right atrial strain derived from cardiovascular magnetic resonance in non-ischemic dilated cardiomyopathy

Abstract

Background The value of right atrial (RA) function in cardiovascular diseases is currently limited. This study was to explore the prognostic value of RA strain derived from fast long axis method by cardiovascular magnetic resonance (CMR) in patients with non-ischemic dilated cardiomyopathy (DCM). Methods We prospectively enrolled patients with DCM who underwent CMR from June 2012 to March 2019 and 120 age- and sex-matched healthy subjects. Fast long-axis strain method was performed to assess the RA phasic function including RA reservoir strain, conduit strain, and booster strain. The predefined primary endpoint was all-cause mortality. The composite heart failure (HF) endpoint included HF death, HF readmission, and heart transplantation. Cox regression analysis and Kaplan–Meier survival curve were performed to describe the association between RA strain and outcomes. Results A total of 624 patients (444 men, mean 48 years) were studied. After a median follow-up of 32.5 months, 116 patients (18.6%) experienced all-cause mortality and 205 patients (32.9%) reached composite HF endpoint. RA function was impaired in DCM patients compared with healthy subjects (all P < 0.001). After adjustment for covariates, RA reservoir strain [hazard ratio (HR) (per 5% decrease) 1.19, 95% confidence interval (CI) 1.03–1.37, P = 0.022] and conduit strain [HR (per 5% decrease) 1.37, 95% CI 1.03–1.84, P = 0.033] were independent predictors of all-cause mortality. Moreover, RA strain added incremental prognostic value for the prediction of adverse cardiac events over baseline clinical and CMR predictors (all P < 0.05). Conclusion RA strain by fast long-axis analysis is independently associated with adverse clinical outcomes in patients with DCM. Trial registration: Trial registration number: ChiCTR1800017058; Date of registration: 2018-07-10 (Retrospective registration); URL: https://www.clinicaltrials.gov

Feasibility and reproducibility of cardiovascular magnetic resonance-feature tracking for quantitative right atrial function in dilated cardiomyopathy patients

“…In accordance with several previous studies based on STE or the fast long-axis method ( 18 , 24 ), we demonstrated that the RA reservoir, conduit, and booster pump function were all impaired in DCM patients, as evidenced by the decreased magnitudes of RA εs, εe, εa, SRs, SRe, and SRa. The mechanism of RA dysfunction in patients with DCM has not been fully elucidated.…”

“…Conversely, cardiovascular magnetic resonance-feature tracking (CMR-FT), a novel technique based on routine balanced steady-state free precession (SSFP) cine sequences, offers higher spatial resolution, better reproducibility, and improved definition of endocardial borders, making it increasingly attractive for evaluating RA phasic functions ( 17 ). Moreover, a very recent study using a fast long-axis method found that RA strain was closely associated with poor outcomes in patients with DCM ( 18 ). Nonetheless, studies focused on RA deformation using CMR-FT in DCM patients are limited.…”

A new staging system using right atrial strain in patients with immunoglobulin light‐chain cardiac amyloidosis

“…[25][26][27] Furthermore, RA structural and functional remodelling are reported risk predictors in several studies. 28,29 The RA also plays an important role in modulating the interactions between the performance of the other heart chambers. Therefore, in patients with AL cardiac amyloidosis, the RA is affected by both direct amyloid deposition and the other chambers.…”

“…Previous studies showed that RA structural and functional remodelling are prevalent in patients with heart failure (HF), pulmonary arterial hypertension, and hypertrophic cardiomyopathy 25–27 . Furthermore, RA structural and functional remodelling are reported risk predictors in several studies 28,29 …”

The Added Value of Advanced Echocardiography for the Morpho-Functional and Prognostic Evaluation of the Right Heart in Dilated Cardiomyopathy: Do Not Forget about the Right Atrium

“…We have demonstrated that the RA function assessed by either 2DSTE as RA strain or 3DE as RA EmF is reduced in DCM compared to that of the control group despite normal RA Vmax values. RA structure and function by CMR are impaired in patients with DCM, and the RA reservoir and conduit strain were demonstrated to be independently associated with adverse clinical outcomes and to have a higher predictive value compared to RA EmF [ 24 ]. However, these findings were demonstrated on Chinese patients, and geographical variations have been found in both RA size and function [ 25 ].…”