Feature-Tracking Global Longitudinal Strain Predicts Death in a Multicenter Population of Patients With Ischemic and Nonischemic Dilated Cardiomyopathy Incremental to Ejection Fraction and Late Gadolinium Enhancement

Background: Pulmonary transit time (PTT) from first-pass perfusion imaging is a novel parameter to evaluate hemodynamic congestion by cardiac magnetic resonance (cMR). We sought to evaluate the additional prognostic value of PTT in heart failure with reduced ejection fraction over other well-validated predictors of risk including the Meta-Analysis Global Group in Chronic Heart Failure risk score and ischemic cause. Methods: We prospectively followed 410 patients with chronic heart failure with reduced ejection fraction (61±13 years, left ventricular (LV) ejection fraction 24±7%) who underwent a clinical cMR to assess the prognostic value of PTT for a primary endpoint of overall mortality and secondary composite endpoint of cardiovascular death and heart failure hospitalization. Normal reference values of PTT were evaluated in a population of 40 asymptomatic volunteers free of cardiovascular disease. Results PTT was significantly increased in patients with heart failure with reduced ejection fraction as compared to controls (9±6 beats and 7±2 beats, respectively, P <0.001), and correlated not only with New York Heart Association class, cMR–LV and cMR–right ventricular (RV) volumes, cMR-RV and cMR-LV ejection fraction, and feature tracking global longitudinal strain, but also with cardiac output. Over 6-year median follow-up, 182 patients died and 200 reached the secondary endpoint. By multivariate Cox analysis, PTT was an independent and significant predictor of both endpoints after adjustment for Meta-Analysis Global Group in Chronic Heart Failure risk score and ischemic cause. Importantly in multivariable analysis, PTT in beats had significantly higher additional prognostic value to predict not only overall mortality (χ 2 to improve, 12.3; hazard ratio, 1.35 [95% CI, 1.16–1.58]; P <0.001) but also the secondary composite endpoints (χ 2 to improve=20.1; hazard ratio, 1.23 [95% CI, 1.21–1.60]; P <0.001) than cMR-LV ejection fraction, cMR-RV ejection fraction, LV–feature tracking global longitudinal strain, or RV–feature tracking global longitudinal strain. Importantly, PTT was independent and complementary to both pulmonary artery pressure and reduced RV ejection fraction<42% to predict overall mortality and secondary combined endpoints. Conclusions: Despite limitations in temporal resolution, PTT derived from first-pass perfusion imaging provides higher and independent prognostic information in heart failure with reduced ejection fraction than clinical and other cMR parameters, including LV and RV ejection fraction or feature tracking global longitudinal strain. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03969394.

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Abstract 17492: Extent and Pattern of Late Gadolinium Enhancement Predict Arrhythmic Events in Patients With Nonischemic Dilated Cardiomyopathy

Circulation ◽

10.1161/circ.132.suppl_3.17492 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Dong Geum Shin ◽

Hye-Jeong Lee ◽

Junbeom Park ◽

Young Jin Kim ◽

Jae-Sun Uhm ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Ventricular Arrhythmia ◽

Dilated Cardiomyopathy ◽

Cardiac Death ◽

Primary Outcome ◽

Multivariable Analysis ◽

Gadolinium Enhancement ◽

Nonischemic Dilated Cardiomyopathy ◽

The Impact

Background: Late gadolinium enhancement (LGE) by cardiac MR (CMR) has been related to adverse clinical outcomes in patients with nonischemic dilated cardiomyopathy (NIDC). But, a statistically significant association between LGE and arrhythmic risk in NIDC has not been demonstrated consistently. This study evaluated the impact of the presence, location and pattern of LGE on arrhythmic risk prediction in NICM. Methods: This study included 365 patients (54±15years) with NICM who underwent CMR. The extent, location and pattern of LGE were categorized. We analyzed for the primary outcome of ventricular arrhythmia (VA) including sustained or nonsustained ventricular tachycardia (VT), appropriate implantable cardioverter-defibrillator (ICD) intervention and ventricular fibrillation (VF). Cardiac death and hospitalization for heart failure (HF) were evaluated as secondary outcomes. Results: LGE was seen in 267 (73 %) patients. During median follow-up of 44±36 months, patients with LGE had higher incidence of cardiac death (15 % vs. 2 %, p<0.001), hospitalization for HF (40 % vs. 15 %, p<0.001) and VA (14% vs. 6%, p=0.03). In multivariable analysis, the presence of LGE (HR 2.78; 95% CI 1.10-7.02; p=0.03) was the independent predictor of arrhythmias. Patients with extensive LGE had higher VA (32% vs. 10%, p<0.001) with lower cumulative survival free of VA than those without extensive LGE (p=0.001). The frequent LGE location was as follows: LV septum 64%, LV-RV junction 42% and inferior 10%. VA was lower in patients with than without localized LGE limited to LV-RV junction (21% vs. 46%, p=0.005). Interestingly, while the incidence of ventricular arrhythmia was higher in patients with transmural LGE (29% vs. 10%, p=0.003), it was lower in those with patch LGE (2% vs. 16%, p=0.02) than the other patients. Conclusions: In patients with NICM, the LGE was an independent prognostic predictor of VA. Extensive LGE and specific location of LGE was related with the arrhythmic events.

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Long-term prognostic value of late gadolinium enhancement in a cohort of patients with nonischemic dilated cardiomyopathy

International Journal of Cardiology ◽

10.1016/j.ijcard.2014.09.110 ◽

2014 ◽

Vol 177 (1) ◽

pp. 17-19 ◽

Cited By ~ 7

Author(s):

Jorge Rodríguez-Capitán ◽

José Manuel García-Pinilla ◽

Isabel Ruiz-Zamora ◽

Eloy Rueda-Calle ◽

Luis Morcillo-Hidalgo ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Dilated Cardiomyopathy ◽

Prognostic Value ◽

Gadolinium Enhancement ◽

Nonischemic Dilated Cardiomyopathy

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Late Gadolinium Enhancement Predicts Improvement in Global Longitudinal Strain after Aortic Valve Replacement in Aortic Stenosis

Scientific Reports ◽

10.1038/s41598-019-51930-2 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Tsuyoshi Fujimiya ◽

Masumi Iwai-Takano ◽

Takashi Igarashi ◽

Hiroharu Shinjo ◽

Keiichi Ishida ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Longitudinal Strain ◽

Severe Aortic Stenosis ◽

Global Longitudinal Strain ◽

Lv Function ◽

Gadolinium Enhancement

Abstract Myocardial fibrosis, as detected by late gadolinium enhancement (LGE) magnetic resonance imaging (MRI), is related to mortality after aortic valve replacement (AVR). This study aimed to determine whether LGEMRI predicts improvement in global longitudinal strain (GLS) after AVR in patients with severe aortic stenosis (AS). Twenty-nine patients with severe AS who were scheduled to undergo AVR were enrolled. Two-dimensional echocardiography and contrast-enhanced MRI were performed before AVR. GLS and LGEcore (g: > 5 SD of normal area), LGEgray (g: 2–5 SD), and LGEcore+gray (g) were measured. One year after AVR, GLS were examined by echocardiography to assess improvement in LV function. Preoperatively, GLS correlated with LGEcore (g) (r2 = 0.14, p < 0.05), LGEgray (g) (r2 = 0.32, p < 0.01) and LGEcore+gray (g) (r2 = 0.36, p < 0.01). LGEcore was significantly lower in patients with improved GLS after AVR (GLS1year ≥ −19.9%) compared to those with no improvement (1.34 g vs. 4.70 g, p < 0.01). LGE predicts improvement in LV systolic function after AVR.

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Prognostic Impact of Combined Late Gadolinium Enhancement on Cardiovascular Magnetic Resonance and Peak Oxygen Consumption in Ambulatory Patients With Nonischemic Dilated Cardiomyopathy

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2014.08.005 ◽

2014 ◽

Vol 20 (11) ◽

pp. 825-832 ◽

Cited By ~ 11

Author(s):

Takashi Yamada ◽

Akihiro Hirashiki ◽

Takahiro Okumura ◽

Shiro Adachi ◽

Shuzo Shimazu ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Oxygen Consumption ◽

Late Gadolinium Enhancement ◽

Magnetic Resonance ◽

Dilated Cardiomyopathy ◽

Peak Oxygen Consumption ◽

Prognostic Impact ◽

Gadolinium Enhancement ◽

Ambulatory Patients ◽

Nonischemic Dilated Cardiomyopathy

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Correlation between septal midwall late gadolinium enhancement on CMR and conduction delay on ECG in patients with nonischemic dilated cardiomyopathy

IJC Heart & Vasculature ◽

10.1016/j.ijcha.2020.100474 ◽

2020 ◽

Vol 26 ◽

pp. 100474

Author(s):

Marthe A.J. Becker ◽

Cornelis P. Allaart ◽

Alwin Zweerink ◽

Jan H. Cornel ◽

Peter M. van de Ven ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Dilated Cardiomyopathy ◽

Conduction Delay ◽

Gadolinium Enhancement ◽

Nonischemic Dilated Cardiomyopathy

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Prognostic significance of longitudinal strain in dilated cardiomyopathy with recovered ejection fraction

Heart ◽

10.1136/heartjnl-2021-319504 ◽

2021 ◽

pp. heartjnl-2021-319504

Author(s):

Marco Merlo ◽

Marco Masè ◽

Andrew Perry ◽

Eluisa La Franca ◽

Elena Deych ◽

...

Keyword(s):

Ejection Fraction ◽

Dilated Cardiomyopathy ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Prognostic Significance ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Risk Of Death

ObjectivePatients with non-ischaemic dilated cardiomyopathy (NICM) may experience a normalisation in left ventricular ejection fraction (LVEF). Although this correlates with improved prognosis, it does not correspond to a normalisation in the risk of death during follow-up. Currently, there are no tools to risk stratify this population. We tested the hypothesis that absolute global longitudinal strain (aGLS) is associated with mortality in patients with NICM and recovered ejection fraction (LVEF).MethodsWe designed a retrospective, international, longitudinal cohort study enrolling patients with NICM with LVEF <40% improved to the normal range (>50%). We studied the relationship between aGLS measured at the time of the first recording of a normalised LVEF and all-cause mortality during follow-up. We considered aGLS >18% as normal and aGLS ≥16% as of potential prognostic value.Results206 patients met inclusion criteria. Median age was 53.5 years (IQR 44.3–62.8) and 56.6% were males. LVEF at diagnosis was 32.0% (IQR 24.0–38.8). LVEF at the time of recovery was 55.0% (IQR 51.7–60.0). aGLS at the time of LVEF recovery was 13.6%±3.9%. 166 (80%) and 141 (68%) patients had aGLS ≤18% and <16%, respectively. During a follow-up of 5.5±2.8 years, 35 patients (17%) died. aGLS at the time of first recording of a recovered LVEF correlated with mortality during follow-up (HR 0.90, 95% CI 0.91 to 0.99, p=0.048 in adjusted Cox model). No deaths were observed in patients with normal aGLS (>18%). In unadjusted Kaplan-Meier survival analysis, aGLS <16% was associated with higher mortality during follow-up (31 deaths (22%) in patients with GLS <16% vs 4 deaths (6.2%) in patients with GLS ≥16%, HR 3.2, 95% CI 1.1 to 9, p=0.03).ConclusionsIn patients with NICM and normalised LVEF, an impaired aGLS at the time of LVEF recovery is frequent and associated with worse outcomes.

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