Author + information
- Received December 4, 2019
- Revision received March 24, 2020
- Accepted April 3, 2020
- Published online September 7, 2020.
- Chetan Shenoy, MBBS, MSa,∗ (, )@cshenoy3,
- Simone Romano, MDb,
- Andrew Hughes, MDa,
- Osama Okasha, MDa,c,
- Prabhjot S. Nijjar, MDa,
- Pratik Velangi, MDa,
- Cindy M. Martin, MDa,
- Mehmet Akçakaya, PhDd and
- Afshin Farzaneh-Far, MD, PhDe
- aDepartment of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
- bDepartment of Medicine, University of Verona, Verona, Italy
- cDepartment of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
- dDepartment of Electrical and Computer Engineering and Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota
- eSection of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
- ↵∗Address for correspondence:
Dr. Chetan Shenoy, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, Minnesota 55455.
Objectives This study determined the long-term prognostic significance of GLS assessed using CMR-FT in a large cohort of heart transplant recipients.
Background In heart transplant recipients, global longitudinal strain (GLS) assessed using echocardiography has shown promise in the prediction of clinical outcomes. We hypothesized that CMR feature tracking (CMR-FT) GLS is independently associated with long-term outcomes in heart transplant recipients.
Methods In a cohort of consecutive heart transplant recipients who underwent routine CMR for clinical surveillance, CMR-FT GLS was calculated from 3 long-axis cine CMR images. Associations between GLS and a composite endpoint of death or major adverse cardiac events (MACE), including retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization, were investigated.
Results A total of 152 heart transplant recipients (age 54 ± 15 years; 29% women; 5.0 ± 5.4 years after heart transplantation) were included. The median GLS was −11.6% (interquartile range: −13.6% to −9.2%). Over a median follow-up of 2.6 years, 59 recipients reached the composite endpoint. On Kaplan-Meier analyses, recipients with GLS worse than the median had a higher estimated cumulative incidence of the composite endpoint compared with recipients with GLS better than the median (log rank p = 0.004). On multivariate Cox proportional hazards regression, GLS was independently associated with the composite endpoint after adjustment for cardiac allograft vasculopathy, history of rejection, left ventricular ejection fraction (LVEF), right ventricular EF, and presence of myocardial fibrosis, with a hazard ratio of 1.15 for every 1% worsening in GLS (95% confidence interval: 1.06 to 1.24; p < 0.001). Similar results were seen in subgroups of recipients with LVEF >50% and with no myocardial fibrosis. GLS provided incremental prognostic value over other variables in the multivariate model as determined by the log-likelihood chi-squared test.
Conclusions In a large cohort of heart transplant recipients, CMR-FT GLS was independently associated with the long-term risk of death or MACE.
Dr. Akçakaya is supported by U.S. National Institutes of Health (NIH) grant R00HL111410. Dr. Shenoy is supported by NIH grant K23HL132011, by University of Minnesota Clinical and Translational Science Institute KL2 Scholars Career Development Program Award (NIH grant KL2TR000113-05), and by National Institutes of Health grant UL1TR000114. All other 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 December 4, 2019.
- Revision received March 24, 2020.
- Accepted April 3, 2020.
- 2020 American College of Cardiology Foundation
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