Author + information
- Received January 12, 2019
- Revision received March 7, 2019
- Accepted March 10, 2019
- Published online March 15, 2019.
- Simone Romano, MD1,
- Benjamin Romer, MD1,
- Kaleigh Evans, MD1,
- Michael Trybula, MD1,
- Chetan Shenoy, MD2,
- Raymond Y. Kwong, MD3 and
- Afshin Farzaneh-Far, MD, PhD1,4,∗ (, )@afshinfarzan
- 1Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- 2Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- 3Division of Cardiology, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
- 4Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
- ↵∗Correspondence to: Afshin Farzaneh-Far, MD, PhD University of Illinois at Chicago Section of Cardiology 840 South Wood St. M/C 715 Suite 920 S Chicago, IL 60612 Telephone: 312-996-6730 Fax: 312-413-2948
Objectives The purpose of this study was to determine the prognostic value of feature tracking global longitudinal strain (GLS) measured during vasodilator stress cardiovascular magnetic resonance (CMR) imaging.
Background Prior studies have suggested that blunted myocardial strain during dobutamine stress echocardiography maybe 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, non-fatal 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 to 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 LGE (HR=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 NRI of 0.898 (95%CI, 0.565-1.124).
Conclusions Feature tracking stress GLS measured during vasodilator stress CMR is an independent predictor of MACE in patients with known or suspected CAD, 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.
- cardiac magnetic resonance imaging
- coronary artery disease
- global longitudinal strain
- stress testing
SOURCES OF FUNDING:
Dr Shenoy was funded by an NIH grant (K23HL132011-01)
- Received January 12, 2019.
- Revision received March 7, 2019.
- Accepted March 10, 2019.
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