Prognostic Implications of Blunted Feature-Tracking Global Longitudinal Strain During Vasodilator Cardiovascular Magnetic Resonance Stress Imaging.
Aged
Coronary Artery Disease
/ diagnostic imaging
Coronary Circulation
Female
Humans
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Observer Variation
Predictive Value of Tests
Progression-Free Survival
Prospective Studies
Purines
/ administration & dosage
Pyrazoles
/ administration & dosage
Reproducibility of Results
Risk Assessment
Risk Factors
Stroke Volume
Time Factors
Vasodilation
Vasodilator Agents
/ administration & dosage
Ventricular Function, Left
cardiac magnetic resonance imaging
coronary artery disease
global longitudinal strain
prognosis
stress testing
Journal
JACC. Cardiovascular imaging
ISSN: 1876-7591
Titre abrégé: JACC Cardiovasc Imaging
Pays: United States
ID NLM: 101467978
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
28
01
2019
revised:
20
02
2019
accepted:
21
02
2019
pubmed:
22
4
2019
medline:
21
7
2020
entrez:
22
4
2019
Statut:
ppublish
Résumé
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. 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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 31005520
pii: S1936-878X(19)30226-8
doi: 10.1016/j.jcmg.2019.03.002
pmc: PMC6745296
mid: NIHMS1524418
pii:
doi:
Substances chimiques
Purines
0
Pyrazoles
0
Vasodilator Agents
0
regadenoson
2XLN4Y044H
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
58-65Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL132011
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 American College of Cardiology Foundation. All rights reserved.
Références
JACC Cardiovasc Imaging. 2010 Apr;3(4):361-71
pubmed: 20394897
Lancet. 2012 Feb 4;379(9814):453-60
pubmed: 22196944
Stat Med. 2008 Jan 30;27(2):157-72; discussion 207-12
pubmed: 17569110
J Cardiovasc Magn Reson. 2016 Aug 26;18(1):51
pubmed: 27561421
JACC Cardiovasc Imaging. 2018 Oct;11(10):1419-1429
pubmed: 29361479
Circ Res. 1991 Sep;69(3):561-70
pubmed: 1873859
JACC Cardiovasc Imaging. 2018 Oct;11(10):1433-1444
pubmed: 29454776
Am Heart J. 2009 Nov;158(5):836-44
pubmed: 19853706
Eur Heart J. 2004 Sep;25(17):1517-25
pubmed: 15342171
Lancet. 2001 Jan 6;357(9249):21-8
pubmed: 11197356
JACC Cardiovasc Imaging. 2019 Sep;12(9):1769-1779
pubmed: 30409557
Heart. 1999 Mar;81(3):229-31
pubmed: 10026340
J Am Coll Cardiol. 2011 Sep 6;58(11):1140-9
pubmed: 21884952
Neth Heart J. 2018 Feb;26(2):85-93
pubmed: 29313213
Br Heart J. 1981 Mar;45(3):248-63
pubmed: 7008815
J Am Coll Cardiol. 2007 Apr 17;49(15):1651-1659
pubmed: 17433958
Eur J Echocardiogr. 2009 Dec;10(8):iii3-7
pubmed: 19889656
Circulation. 2007 Mar 13;115(10):1252-9
pubmed: 17325245
Circulation. 2017 Jun 6;135(23):2313-2315
pubmed: 28584033
JACC Cardiovasc Imaging. 2019 Aug;12(8 Pt 2):1686-1695
pubmed: 30409558
JACC Cardiovasc Imaging. 2014 Jan;7(1):23-5
pubmed: 24433708
Stat Med. 2004 Jul 15;23(13):2109-23
pubmed: 15211606
J Am Coll Cardiol. 2009 Dec 29;55(1):1-16
pubmed: 20117357
Circulation. 2013 Aug 6;128(6):605-14
pubmed: 23804252
Int J Cardiol Heart Vasc. 2018 Mar 06;18:46-51
pubmed: 29876503
JACC Cardiovasc Imaging. 2013 May;6(5):600-9
pubmed: 23582358
Heart. 1999 Feb;81(2):111-3
pubmed: 9922343
Br J Radiol. 2017 Dec;90(1080):20170072
pubmed: 28830199