Author + information
- Received April 20, 2017
- Revision received September 18, 2017
- Accepted September 25, 2017
- Published online October 1, 2018.
- Jose Gavara, MSca,∗,
- Jose F. Rodriguez-Palomares, MD, PhDb,∗,
- Filipa Valente, MDb,
- Jose V. Monmeneu, MD, PhDc,
- Maria P. Lopez-Lereu, MD, PhDc,
- Clara Bonanad, MD, PhDa,
- Ignacio Ferreira-Gonzalez, MD, PhDb,d,
- Bruno Garcia del Blanco, MD, PhDb,
- Julian Rodriguez-Garcia, MDb,
- Maria Mutuberria, MD, PhDb,
- Elena de Dios, MSca,
- Cesar Rios-Navarro, MSca,
- Nerea Perez-Sole, BSca,
- Paolo Racugno, MDa,
- Ana Paya, MDa,
- Gema Minana, MD, PhDa,
- Joaquim Canoves, MD, PhDa,e,
- Mauricio Pellicer, MDa,
- Francisco J. Lopez-Fornas, MD, PhDa,
- Jose Barrabes, MD, PhDb,
- Arturo Evangelista, MD, PhDb,
- Julio Nunez, MD, PhDa,
- Francisco J. Chorro, MD, PhDa,e,
- David Garcia-Dorado, MD, PhDb,e,∗∗ ( and )
- Vicente Bodi, MD, PhDa,e,∗ ()
- aDepartment of Cardiology, Hospital Clinico Universitario, INCLIVA, University of Valencia, Valencia, Spain
- bHospital Universitari Vall d’Hebron, Department of Cardiology, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- cCardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain
- dCentro de Investigación Biomédica en Red-ESP, Madrid, Spain
- eCentro de Investigación Biomédica en Red-CV, Madrid, Spain
- ↵∗Address for correspondence:
Dr. Vicente Bodi, Department of Cardiology, Hospital Clinico Universitario-CIBERCV, INCLIVA, University of Valencia, Blasco Ibañez 17, 46010, Valencia, Spain.
- ↵∗∗Dr. David Garcia-Dorado, Cardiovascular Diseases Research Group, Department of Cardiology, Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Objectives The aim of this study was to evaluate the prognostic value of strain as assessed by tissue tracking (TT) cardiac magnetic resonance (CMR) soon after ST-segment elevation myocardial infarction (STEMI).
Background The prognostic value of myocardial strain as assessed post-STEMI by TT-CMR is unknown.
Methods The authors studied the prognostic value of TT-CMR in 323 patients who underwent CMR 1 week post-STEMI. Global (average of peak segmental values [%]) and segmental (number of altered segments) longitudinal (LS), circumferential, and radial strain were assessed using TT-CMR. Global and segmental strain cutoff values were derived from 32 control patients. CMR-derived left ventricular ejection fraction, microvascular obstruction, and infarct size were determined. Results were validated in an external cohort of 190 STEMI patients.
Results During a median follow-up of 1,085 days, 54 first major adverse cardiac events (MACE), which included 10 cardiac deaths, 25 readmissions for heart failure, and 19 readmissions for reinfarction were documented. MACE was associated with more severe abnormalities in all strain indexes (p < 0.001), although only global LS was an independent predictor (p < 0.001). The MACE rate was higher in patients with a global LS of ≥−11% (22% vs. 9%; p = 0.001). After adjustment for baseline and CMR variables, global LS (hazard ratio [HR]: 1.21; 95% confidence interval [CI]: 1.11 to 1.32; p < 0.001) was associated with MACE. In the external validation cohort, a global LS ≥−11% was seen in a higher proportion of patients with MACE (34% vs. 9%; p < 0.001). Global LS predicted MACE after adjustment for baseline and CMR variables (HR: 1.18; 95% CI: 1.04 to 1.33; p = 0.008). The addition of global LS to the multivariate models, including baseline and CMR variables, did not significantly improve the categorical net reclassification improvement index in either the study group (−0.015; p = 0.7) or in the external validation cohort (−0.019; p = 0.9).
Conclusions TT-CMR provided prognostic information soon after STEMI. However, it did not substantially improve risk reclassification beyond traditional CMR indexes.
↵∗ Drs. Gavara and Rodriguez-Palomares contributed equally to this work.
This work was supported by the Instituto de Salud Carlos III and co-funded by FEDER (grant numbers PI14/00271, PIE15/00013, CIBERCV16/11/00486, CIBERCV16/11/00479) and the Generalitat Valenciana (grant number PROMETEO/2013/007).
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 20, 2017.
- Revision received September 18, 2017.
- Accepted September 25, 2017.
- 2018 American College of Cardiology Foundation