Objectives: The purpose of this study was to determine the prognostic value of feature-tracking global longitudinal strain (GLS) measured during vasodilator stress cardiac magnetic resonance (CMR) imaging. Background: Prior studies have suggested that blunted myocardial strain during dobutamine stress echocardiography may be associated with adverse prognosis. Recent developments in CMR feature-tracking techniques now allow assessment of strain in clinical practice using standard cine images without specialized pulse sequences or complex post-processing. Whether feature-tracking GLS measured during vasodilator stress provides independent and incremental prognostic data is unclear. Methods: Consecutive patients undergoing stress perfusion CMR were prospectively enrolled (n = 535). Feature-tracking stress GLS was measured immediately after regadenoson perfusion. Patients were followed for major adverse cardiac events (MACE): death, nonfatal myocardial infarction, heart failure hospitalization, sustained ventricular tachycardia, and late revascularization. Cox proportional hazards regression modeling was used to examine the association between stress GLS and MACE. The incremental prognostic value of stress GLS was assessed in nested models. Results: Over a median follow-up of 1.5 years, 82 patients experienced MACE. By Kaplan-Meier analysis, patients with stress GLS ≥ median (-19%) had significantly reduced event-free survival compared with those with stress GLS < median (log-rank p < 0.001). Stress GLS was significantly associated with risk of MACE after adjustment for clinical and imaging risk factors including ischemia, ejection fraction, and late gadolinium enhancement (hazard ratio: 1.267; p < 0.001). Addition of stress GLS into a model with clinical and imaging predictors resulted in significant increase in the C-index (from 0.80 to 0.85; p = 0.031) and a continuous net reclassification improvement of 0.898 (95% confidence interval: 0.565 to 1.124). Conclusions: Feature-tracking stress GLS measured during vasodilator stress CMR is an independent predictor of MACE in patients with known or suspected coronary artery disease, incremental to common clinical and imaging risk factors. These findings suggest a role for feature-tracking derived stress GLS in identifying patients at highest risk of adverse events following stress CMR.

Prognostic Implications of Blunted Feature-Tracking Global Longitudinal Strain During Vasodilator Cardiovascular Magnetic Resonance Stress Imaging

Romano, Simone;
2020-01-01

Abstract

Objectives: The purpose of this study was to determine the prognostic value of feature-tracking global longitudinal strain (GLS) measured during vasodilator stress cardiac magnetic resonance (CMR) imaging. Background: Prior studies have suggested that blunted myocardial strain during dobutamine stress echocardiography may be associated with adverse prognosis. Recent developments in CMR feature-tracking techniques now allow assessment of strain in clinical practice using standard cine images without specialized pulse sequences or complex post-processing. Whether feature-tracking GLS measured during vasodilator stress provides independent and incremental prognostic data is unclear. Methods: Consecutive patients undergoing stress perfusion CMR were prospectively enrolled (n = 535). Feature-tracking stress GLS was measured immediately after regadenoson perfusion. Patients were followed for major adverse cardiac events (MACE): death, nonfatal myocardial infarction, heart failure hospitalization, sustained ventricular tachycardia, and late revascularization. Cox proportional hazards regression modeling was used to examine the association between stress GLS and MACE. The incremental prognostic value of stress GLS was assessed in nested models. Results: Over a median follow-up of 1.5 years, 82 patients experienced MACE. By Kaplan-Meier analysis, patients with stress GLS ≥ median (-19%) had significantly reduced event-free survival compared with those with stress GLS < median (log-rank p < 0.001). Stress GLS was significantly associated with risk of MACE after adjustment for clinical and imaging risk factors including ischemia, ejection fraction, and late gadolinium enhancement (hazard ratio: 1.267; p < 0.001). Addition of stress GLS into a model with clinical and imaging predictors resulted in significant increase in the C-index (from 0.80 to 0.85; p = 0.031) and a continuous net reclassification improvement of 0.898 (95% confidence interval: 0.565 to 1.124). Conclusions: Feature-tracking stress GLS measured during vasodilator stress CMR is an independent predictor of MACE in patients with known or suspected coronary artery disease, incremental to common clinical and imaging risk factors. These findings suggest a role for feature-tracking derived stress GLS in identifying patients at highest risk of adverse events following stress CMR.
2020
cardiac magnetic resonance imaging
coronary artery disease
global longitudinal strain
prognosis
stress testing
Aged
Coronary Artery Disease
Female
Humans
Male
Middle Aged
Observer Variation
Predictive Value of Tests
Progression-Free Survival
Prospective Studies
Purines
Pyrazoles
Reproducibility of Results
Risk Assessment
Risk Factors
Time Factors
Vasodilator Agents
Coronary Circulation
Magnetic Resonance Imaging, Cine
Stroke Volume
Vasodilation
Ventricular Function, Left
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1060160
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