Usefulness of Left Ventricular Strain by Cardiac Magnetic Resonance Feature-Tracking to Predict Cardiovascular Events in Patients With and Without Heart Failure

Sardana, Mayank; Konda, Prasad; Hashmath, Zeba; Oldland, Garrett; Gaddam, Swetha; Miller, Rachana; Satija, Vaibhav; Ansari, Bilal; Lee, Jonathan J.; Mustafa, Anique; Akers, Scott; Chirinos, Julio A.

doi:10.1016/j.amjcard.2019.01.025

Cited by 18 publications

(15 citation statements)

References 24 publications

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“…Case in point, in the current study, GLS_ENDO, GLS_AVE and GLS_EPI and even LVEF were all significantly predictive of outcomes in univariable analysis, but of these only GLS_AVE remained independently associated with clinical outcomes when including NT-proBNP and age in the outcomes model. Similar to our findings, a recent CMR feature tracking study showed that GLS_AVE and GRS were predictive of outcomes in HF [ 35 ]. Different from our study, GCS_AVE was also shown to be predictive of outcomes.…”

Section: Discussionsupporting

confidence: 92%

Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the same

Pagano

Haykowksy

et al. 2020

Journal of Cardiovascular Magnetic Resonance

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Background Global longitudinal strain (GLS), most commonly measured at the endocardium, has been shown to be superior to left ventricular (LV) ejection fraction (LVEF) for the identification of systolic dysfunction and prediction of outcomes in heart failure (HF). We hypothesized that strains measured at different myocardial layers (endocardium = ENDO, epicardium = EPI, average = AVE) will have distinct diagnostic and predictive performance for patients with HF. Methods Layer-specific GLS, layer-specific global circumferential strain (GCS) and global radial strain (GRS) were evaluated by cardiovascular magnetic resonance imaging (CMR) feature tracking in the Alberta HEART study. A total of 453 subjects consisted of healthy controls (controls, n = 77), at-risk for HF (at-risk, n = 143), HF with preserved ejection fraction (HFpEF, n = 87), HF with mid-range ejection fraction (HFmrEF, n = 88) and HF with reduced ejection fraction (HFrEF, n = 58). For outcomes analysis, CMR-derived imaging parameters were adjusted with a base model that included age and N-terminal prohormone of b-type natriuretic peptide (NT-proBNP) to test their independent association with 5-year all-cause mortality. Results GLS_EPI distinguished all groups with preserved LVEF (controls − 16.5 ± 2.4% vs. at-risk − 15.5 ± 2.7% vs. HFpEF − 14.1 ± 3.0%, p < 0.001) while GLS_ENDO and all GCS (all layers) were similar among these groups. GRS was reduced in HFpEF (41.1 ± 13.8% versus 48.9 ± 10.7% in controls, p < 0.001) and the difference between GLS_EPI and GLS_ENDO were significantly larger in HFpEF as compared to controls. Within the preserved LVEF groups, reduced GRS and GLS_EPI were significantly associated with increased LV mass (LVM) and LVM/LV end-diastolic volume EDV (concentricity). In multivariable analysis, only GLS_AVE and GRS predicted 5-year all-cause mortality (all ps < 0.05), with the strongest association with 5-year all-cause mortality by Akaike Information Criterion analysis and significant incremental value for outcomes prediction beyond LVEF or GLS_ENDO by the likelihood ratio test. Conclusion Global strains measured on endocardium, epicardium or averaged across the wall thickness are not equivalent for the identification of systolic dysfunction or outcomes prediction in HF. The endocardium-specific strains were shown to have poorest all-around performance. GLS_AVE and GRS were the only CMR parameters to be significantly associated with 5-year all-cause mortality in multivariable analysis. GLS_EPI and GRS, as well as the difference in endocardial and epicardial strains, were sensitive to systolic dysfunction among HF patients with normal LVEF (> 55%), in whom lower strains were associated with increased concentricity.

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Section: Discussionsupporting

confidence: 92%

Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the same

Pagano

Haykowksy

et al. 2020

Journal of Cardiovascular Magnetic Resonance

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“…LVEF has been recognized as the routine prognostic parameter and reference standard of LV global systolic function. However, LVEF is only a representative of LV geometric change other than the function change 18 , which indicates EF may be inaccessible to identify subtle and mild degrees of LV systolic abnormalities [19][20][21][22][23] . Maciver et al reported that although longitudinal systolic strain had been reduced, EF may be normal by compensated with the increased radial wall thickness in LV hypertrophy 24 .…”

Section: Discussionmentioning

confidence: 99%

Early and Quantitative Assessment of Myocardial Deformation in Essential Hypertension Patients by Using Cardiovascular Magnetic Resonance Feature Tracking

Liu

Wang

Pan

et al. 2020

Sci Rep

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the aims of the study were to identify subclinical global systolic function abnormalities and evaluate influencing factors associated with left ventricular (LV) strain parameters in hypertensive subjects using cardiovascular magnetic resonance imaging feature tracking (CMR-FT). The study enrolled 57 patients with essential hypertension (mean age: 43.04 ± 10.90 years; 35 males) and 26 healthy volunteers (mean age: 38.69 ± 10.44 years; 11 males) who underwent clinical evaluation and CMR examination. Compared with controls, hypertensive patients had significantly impaired myocardial strain values while ejection fraction (EF) did not differ. After multivariate regression analyses adjustment for confounders, the global radial strains (GRS) was independently associated with the mean arterial pressure (MAP) and left ventricular mass index (LVMI) (β = −0.219, p = 0.009 and β = −0.224, p = 0.015, respectively; Adjusted R 2 = 0.4); the global circumferential strains (GCS) was also independently associated with the MAP and LVMI (β = 0.084, p = 0.002 and β = 0.073, p = 0.01, respectively; Adjusted R 2 = 0.439); the global longitudinal strains (GLS) was independently associated with the Age and MAP (β = 0.065, p = 0.021 and β = 0.077, p = 0.009, respectively; Adjusted R 2 = 0.289). Myocardial strain can early detect the myocardial damage and may be an appropriate target for preventive strategies before abnormalities of EF. Essential hypertension is defined as a rise in blood pressure which can increase risks for cerebral, cardiac, and renal events with unknown reason 1. Hypertension remains deserving for more attention since it is a potent risk factor for cardiovascular diseases and it may brings considerable morbidity and mortality 1-4. Given the prevalence of hypertension in the population, early identifying subclinical left ventricular (LV) systolic dysfunction among hypertensive subjects might have an important role in assessing the prognosis and choosing treatment strategies. Strain imaging has emerged as a sensitive and powerful tool to detect early and subtle myocardial dysfunction in various cardiac diseases, and may provide a novel method for LV risk assessment in hypertensive patients 5-7. Myocardial strain was first used by cardiovascular magnetic resonance (CMR) tagging in 1988 8. CMR tagging has been the most available and reproducible method to quantify the myocardial deformation and remains the reference standard for evaluating myocardial strain 9,10. However, CMR tagging needs to acquire additional sequences and its post processing is time-consuming. The spatial resolution of tagging is quite low, which is another limitation of tagging. Therefore, CMR tagging has not yet been widely applied in clinical circumstances. Speckle tracking echocardiography (STE) has solved these issues to a large extent, but it is still limited by the observer dependency, signal noise, angle dependency, inadequate acoustic windows and poor image quality 11-13. Cardiovascular magnetic resonance imaging feature tracking (CMR-FT), whic...

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“…This finding was evident in 50% of the patients, whereas global longitudinal strain was reportedly much lower in the anaphylaxis group than in the equivalent group with urticaria. Indeed, a lower global longitudinal strain has been recently associated with a higher long-term risk of cardiovascular morbidity and mortality in a low-risk general population (62,63).…”

Section: Kounis Syndrome As a Predominant Feature Of Anaphylaxismentioning

confidence: 99%

Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease

Kounis¹,

Koniari²,

Velissaris³

et al. 2019

Balkan Med J

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Coronary symptoms associated with conditions related to mast cell activation and inflammatory cell interactions, such as those involving T-lymphocytes and macrophages, further inducing allergic, hypersensitivity, anaphylactic, or anaphylactic insults, are currently referred to as the Kounis syndrome. Kounis syndrome is caused by inflammatory mediators released during allergic insults, postinflammatory cell activation, and interactions via multidirectional stimuli. A platelet subset of 20% with high-and low-affinity IgE surface receptors is also involved in this process. Kounis syndrome is not just a single-organ but also a complex multisystem and multiorgan arterial clinical condition; it affects the coronary, mesenteric, and cerebral arteries and is accompanied by allergy-hypersensitivityanaphylaxis involving the skin, respiratory, and vascular systems in the context of anesthesia, surgery, radiology, oncology, or even dental and psychiatric medicine; further, it has significantly influences both morbidity and mortality. Kounis syndrome might be caused by numerous and continuously increasing causes, with broad clinical symptoms and signs, via multi-organ arterial system involvement, in patients of any age, thereby demonstrating predominant anaphylactic features in terms of a wide spectrum of mast cell-association disorders. Cardiac symptoms, such as chest pain, coronary vasospasm, angina pectoris, myocardial infarction, stent thrombosis, acute cardiac failure, and sudden cardiac death associated with subclinical, clinical, acute, or chronic allergic reactions, constitute the clinical manifestations of this syndrome. Since its first description, a common pathway between allergic and non-allergic coronary events has been demonstrated. The hypothesis is based on the existence of a much higher degree of mast cell degranulation at plaque erosion or rupture sites compared with at the adjacent areas or even more distant segments in post-acute myocardial infarction of non-allergic etiology. Although mast cell activation, differentiation, and mediator release takes days or weeks, the mast cell degranulation may occur just before any acute coronary event, further resulting in coronary artery vasoconstriction and atheromatous plaque rupture. It seems that medications and natural molecules stabilizing the mast cell membrane as well as monoclonal antibodies protecting the mast cell surface can emerge as novel therapeutic modalities for acute coronary and cerebrovascular event prevention.

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Usefulness of Left Ventricular Strain by Cardiac Magnetic Resonance Feature-Tracking to Predict Cardiovascular Events in Patients With and Without Heart Failure

Cited by 18 publications

References 24 publications

Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the same

Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the same

Early and Quantitative Assessment of Myocardial Deformation in Essential Hypertension Patients by Using Cardiovascular Magnetic Resonance Feature Tracking

Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease

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