Author + information
- Received October 10, 2019
- Revision received May 12, 2020
- Accepted May 22, 2020
- Published online October 5, 2020.
- Jiwon Kim, MDa,∗ (, )
- Brian Yum, MDa,
- Maria C. Palumbo, MSa,
- Razia Sultana, BAa,
- Nathaniel Wright, BSa,
- Mukund Das, MDa,
- Cindy You, MDa,
- Chaya S. Moskowitz, PhDb,
- Robert A. Levine, MDc,
- Richard B. Devereux, MDa and
- Jonathan W. Weinsaft, MDa,d
- aGreenberg Cardiology Division, Department of Medicine, Weill Cornell Medicine, New York, New York
- bDepartment of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
- cDepartment of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- dDepartment of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- ↵∗Address for correspondence:
Dr. Jiwon Kim, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, New York 10021.
Objectives The aims of this study were to test the magnitude of agreement between echocardiography (echo)- and cardiac magnetic resonance (CMR)–derived left atrial (LA) strain and to study their relative diagnostic performance in discriminating diastolic dysfunction (DD) and predicting atrial fibrillation (AF).
Backgrounds Peak atrial longitudinal strain (PALS) is a novel performance index. Utility of echo-quantified LA strain has yet to be prospectively tested in relation to current DD guidelines or compared to CMR.
Methods The study population comprised 257 post-myocardial infarction (MI) patients undergoing echo and CMR, including prospective derivation (n = 157) and clinical validation (n = 100) cohorts. DD was graded on echo using established consensus guidelines blinded to strain results.
Results PALS on both echo and CMR was nearly 2-fold lower among patients with versus no DD (p < 0.001) and was significantly different in those with mild versus no DD (p < 0.01). In contrast, LA geometric parameters including echo- and CMR-derived volumes were significantly different between advanced versus no DD groups (p < 0.001) but not between groups with mild versus no DD (all p > 0.05). Echo and CMR PALS yielded small differences irrespective of orientation and similar diagnostic performance for DD in the derivation (area under the curve [AUC]: 0.70 to 0.78) and validation (AUC: 0.75 to 0.78) cohorts. Impaired PALS on both modalities was independently associated with MI size (p < 0.001). During 4.4 ± 3.8 years of follow-up in the derivation cohort, 8% developed AF. Both 2-chamber echo- and CMR-derived PALS stratified arrhythmic risk (p = 0.004 and p = 0.02, respectively), including a 4-fold difference among patients in the lowest versus remainder of quartiles of echo-derived PALS (24% vs. 6%). Similarly, echo and CMR PALS were lower (both p < 0.05) among patients with subsequent heart failure hospitalizations.
Conclusions Echo-derived PALS parallels results of CMR, yields incremental diagnostic utility versus LA geometry for stratifying presence and severity of DD, and improves prediction of AF and congestive heart failure after MI.
This study was supported by National Institutes of Health (NIH) grant 1K23 HL140092-01 to Dr. Kim; NIH grant 1R01HL128278-01 to Dr. Weinsaft; and Memorial Sloan Kettering Cancer Center core grant P30 CA008748 to Dr. Moskowitz. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received October 10, 2019.
- Revision received May 12, 2020.
- Accepted May 22, 2020.
- 2020 American College of Cardiology Foundation
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