Author + information
- Received July 14, 2017
- Revision received October 6, 2017
- Accepted October 12, 2017
- Published online October 1, 2018.
- Simone Romano, MDa,b,
- Robert M. Judd, PhDc,
- Raymond J. Kim, MDc,
- Han W. Kim, MDc,
- Igor Klem, MDc,
- John F. Heitner, MDd,
- Dipan J. Shah, MDe,
- Jennifer Jue, MDa,
- Brent E. White, MDa,
- Raksha Indorkar, MDa,
- Chetan Shenoy, MDc and
- Afshin Farzaneh-Far, MD, PhDa,∗ ()
- aDivision of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
- bDepartment of Medicine, University of Verona, Verona, Italy
- cDivision of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
- dDepartment of Cardiology, New York Methodist Hospital, New York, New York
- eHouston Methodist DeBakey Heart & Vascular Center, Houston, Texas
- ↵∗Address for correspondence:
Dr. Afshin Farzaneh-Far, University of Illinois at Chicago, Section of Cardiology, 840 South Wood Street, M/C 715, Suite 920 S, Chicago, Illinois 60612.
Objectives The aim of this study was to evaluate the prognostic value of cardiac magnetic resonance (CMR) feature-tracking–derived global longitudinal strain (GLS) in a large multicenter population of patients with ischemic and nonischemic dilated cardiomyopathy.
Background Direct assessment of myocardial fiber deformation with GLS using echocardiography or CMR feature tracking has shown promise in providing prognostic information incremental to ejection fraction (EF) in single-center studies. Given the growing use of CMR for assessing persons with left ventricular (LV) dysfunction, we hypothesized that feature-tracking–derived GLS may provide independent prognostic information in a multicenter population of patients with ischemic and nonischemic dilated cardiomyopathy.
Methods Consecutive patients at 4 U.S. medical centers undergoing CMR with EF <50% and ischemic or nonischemic dilated cardiomyopathy were included in this study. Feature-tracking GLS was calculated from 3 long-axis cine-views. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the association between GLS and death. Incremental prognostic value of GLS was assessed in nested models.
Results Of the 1,012 patients in this study, 133 died during median follow-up of 4.4 years. By Kaplan-Meier analysis, the risk of death increased significantly with worsening GLS tertiles (log-rank p < 0.0001). Each 1% worsening in GLS was associated with an 89.1% increased risk of death after adjustment for clinical and imaging risk factors including EF and late gadolinium enhancement (LGE) (hazard ratio [HR]:1.891 per %; p < 0.001). Addition of GLS in this model resulted in significant improvement in the C-statistic (0.628 to 0.867; p < 0.0001). Continuous net reclassification improvement (NRI) was 1.148 (95% confidence interval: 0.996 to 1.318). GLS was independently associated with death after adjustment for clinical and imaging risk factors (including EF and late gadolinium enhancement) in both ischemic (HR: 1.942 per %; p < 0.001) and nonischemic dilated cardiomyopathy subgroups (HR: 2.101 per %; p < 0.001).
Conclusions CMR feature-tracking–derived GLS is a powerful independent predictor of mortality in a multicenter population of patients with ischemic or nonischemic dilated cardiomyopathy, incremental to common clinical and CMR risk factors including EF and LGE.
- cardiac magnetic resonance imaging
- feature tracking
- global longitudinal strain
- left ventricular function
Dr. R.J. Kim was funded in part by an NIH grant (RO1-HL64726). Dr. Shenoy was funded by an NIH grant (K23HL132011-01). Drs. R.J. Kim and Judd are inventors of a U.S. patent on delayed-enhancement MRI owned by Northwestern University. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 14, 2017.
- Revision received October 6, 2017.
- Accepted October 12, 2017.
- 2018 American College of Cardiology Foundation
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