scholarly journals The combined incremental prognostic value of left ventricular ejection fraction, late gadolinium enhancement and global circumferential strain assessed by cardiovascular magnetic resonance

2015 ◽  
Vol 17 (S1) ◽  
Author(s):  
Ify Mordi ◽  
Hiram Bezerra ◽  
David Carrick ◽  
Nikolaos Tzemos
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Left Ventricular Ejection Fraction ◽  
Prognostic Value ◽  
Circumferential Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Gadolinium Enhancement ◽  
Ventricular Ejection Fraction ◽  
Incremental Prognostic Value

scholarly journals Safety and Prognostic Value of Vasodilator Stress Cardiovascular Magnetic Resonance in Patients With Heart Failure and Reduced Ejection Fraction

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Théo Pezel ◽  
Francesca Sanguineti ◽  
Marine Kinnel ◽  
Valentin Landon ◽  
Guillaume Bonnet ◽  
...  
Keyword(s):  
Heart Failure ◽  
Late Gadolinium Enhancement ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Gadolinium Enhancement ◽  
Ventricular Ejection Fraction ◽  
Inducible Ischemia

Background: Patients with heart failure with reduced ejection fraction (HFrEF; heart failure with reduced left ventricular ejection fraction <40%) referred for stress cardiovascular magnetic resonance (CMR) may have a less optimal hemodynamic response to intravenous vasodilator. The aim was to assess the prognostic value of vasodilator stress perfusion CMR in patients with HFrEF. Methods: Between 2008 and 2018, consecutive patients with HFrEF defined by left ventricular ejection fraction <40% prospectively referred for vasodilator stress perfusion CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. Univariable and multivariable Cox regressions were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement by CMR. Results: Of 1053 patients with HFrEF (65±11 years, median [interquartile range] left ventricular ejection fraction 38.7% [37.2–39.0]), 1018 (97%) completed the CMR protocol and 950 (93%) completed the follow-up (median [interquartile range], 5.6 [3.6–7.3] years); 117 experienced a MACE (12.3%). Stress CMR was well tolerated without any adverse events. Patients without ischemia or late gadolinium enhancement experienced a lower annual event rate of MACE (1.8%) than those with both ischemia and late gadolinium enhancement (12.0%; P <0.001). Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement were significantly associated with the occurrence of MACE (hazard ratio, 2.46 [95% CI, 1.69–3.60]; and hazard ratio, 2.92 [95% CI, 1.77–4.83], respectively, both P <0.001). In multivariable Cox regression, inducible ischemia was an independent predictor of a higher incidence of MACE (hazard ratio, 2.26 [95% CI, 1.52–3.35]; P <0.001). Conclusions: Stress CMR is safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients with HFrEF.

scholarly journals Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis

2020 ◽  
Vol 41 (18) ◽  
pp. 1733-1743 ◽  
Author(s):  
Lili Zhang ◽  
Magid Awadalla ◽  
Syed S Mahmood ◽  
Anju Nohria ◽  
Malek Z O Hassan ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Immune Checkpoint ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Gadolinium Enhancement ◽  
Ventricular Ejection Fraction

Abstract Aims Myocarditis is a potentially fatal complication of immune checkpoint inhibitors (ICI). Sparse data exist on the use of cardiovascular magnetic resonance (CMR) in ICI-associated myocarditis. In this study, the CMR characteristics and the association between CMR features and cardiovascular events among patients with ICI-associated myocarditis are presented. Methods and results From an international registry of patients with ICI-associated myocarditis, clinical, CMR, and histopathological findings were collected. Major adverse cardiovascular events (MACE) were a composite of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block. In 103 patients diagnosed with ICI-associated myocarditis who had a CMR, the mean left ventricular ejection fraction (LVEF) was 50%, and 61% of patients had an LVEF ≥50%. Late gadolinium enhancement (LGE) was present in 48% overall, 55% of the reduced EF, and 43% of the preserved EF cohort. Elevated T2-weighted short tau inversion recovery (STIR) was present in 28% overall, 30% of the reduced EF, and 26% of the preserved EF cohort. The presence of LGE increased from 21.6%, when CMR was performed within 4 days of admission to 72.0% when CMR was performed on Day 4 of admission or later. Fifty-six patients had cardiac pathology. Late gadolinium enhancement was present in 35% of patients with pathological fibrosis and elevated T2-weighted STIR signal was present in 26% with a lymphocytic infiltration. Forty-one patients (40%) had MACE over a follow-up time of 5 months. The presence of LGE, LGE pattern, or elevated T2-weighted STIR were not associated with MACE. Conclusion These data suggest caution in reliance on LGE or a qualitative T2-STIR-only approach for the exclusion of ICI-associated myocarditis.

scholarly journals Myocardial strain overrules left ventricular ejection fraction and late gadolinium enhancement extent in predicting MACE in CMR-proven acute myocarditis

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
JL Vos ◽  
AG Raafs ◽  
N Van Der Velde ◽  
T Germans ◽  
PS Biesbroek ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Acute Myocarditis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diagnostic Process ◽  
Gadolinium Enhancement ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac magnetic resonance (CMR) plays a major role in both the diagnostic process and prognostic stratification in acute myocarditis. Presence of late gadolinium enhancement (LGE) and left ventricular (LV) ejection fraction (EF) are known predictors of major adverse cardiovascular events (MACE). However, in daily clinical practice it remains challenging to distinguish ‘the good from the bad’. The prognostic value of CMR feature tracking (FT) derived strain, with respect to LGE and LVEF, remains unclear. Purpose To evaluate the incremental prognostic value of left atrial (LA) phasic function, LV and right ventricular (RV) strain using CMR-FT in patients with CMR-proven acute myocarditis. Methods In this multicenter observational study, patients with CMR-proven acute myocarditis were included and followed with regard to MACE including all-cause mortality (ACM), heart-failure hospitalizations (HFH), and life-threatening arrhythmias (LTA). Using FT-derived strain, LV global longitudinal strain (GLS), circumferential strain (GCS), and radial strain (GRS), RV GLS and LA phasic function were measured. Uni- and multivariable analysis including clinical and CMR parameters were performed to assess the association with MACE. Results A total of 162 patients were included (75% male, 41 ±17 years). MACE occurred in 29 patients (18%, ACM n = 18, HFH n = 7, LTA n = 11) during a median follow-up of 5.5 (2.2-8.3) years. Forty-six percent had a STEMI-like presentation (combination of chest pain, elevated troponin, and ST-elevation, n = 74). LGE was present in 90% of patients and mean LVEF was 51 ± 12%. Patients with LVEF &lt;50% had a significantly worse prognosis compared to patients with LVEF ≥50% (p &lt; 0.0001, Figure A). When we categorized the study population into subgroups of quartile values of LV GLS, patients with LV GLS worse than 18% had a significant worse outcome compared to the other subgroups (p &lt; 0.05, Figure B). Subgroups of LGE extent did not show significantly different associations with outcome (p = 0.458, Figure C). Cox regression analysis showed that LV strain and LA phasic function were univariably associated with MACE, whereas RV GLS and LGE extent were not. All univariable associated strain parameters were separately included in a multivariable model, including age, sex, STEMI-like presentation, and LVEF. LV GLS (HR 1.08, p = 0.01), LV GCS (HR 1.15, p = 0.02), and LV GRS (HR 0.98, p = 0.02) were independent predictors of MACE. Conclusions LV strain parameters are independent and incremental predictors of prognosis in patients with acute myocarditis, while RV strain and LA phasic function are not. Therefore, LV strain is a promising novel parameter for risk stratification in acute myocarditis.

Abstract 128: Changes in Left Ventricular Ejection Fraction Predict Survival and Hospitalization in Heart Failure With Reduced Ejection Fraction

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Khadijah Breathett ◽  
Larry A Allen ◽  
James Udelson ◽  
Gordon Davis ◽  
Michael Bristow
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Response To Therapy ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Incremental Prognostic Value

Background: Left ventricular remodeling, as commonly measured by left ventricular ejection fraction (LVEF), is associated with clinical outcomes. Although change in LVEF over time would be anticipated to reflect response to therapy and subsequent clinical course, systematic serial measurement of LVEF is inconsistent in observational settings, and has not been systematically reported in large-scale clinical trials. Thus the incremental prognostic value of change in LVEF has not been well characterized. Methods: The Beta-Blocker Evaluation of Survival Trial (BEST, 1995-1999) collected LVEF by radionuclide ventriculography at baseline and at 3 and 12-months after randomization. Change in LVEF was defined as change from baseline to 12-month unless that value was missing, in which case the 3-month value was used. We built a series of multivariable models including 16 commonly used clinical parameters plus change in LVEF for predicting the following time to first event endpoints: all-cause mortality (ACM), cardiovascular mortality (CVM), heart failure hospitalization (HFH), and ACM or HFH. Results: Among 2,484 patients with a mean follow-up of 2-years, serial improvement in LVEF by ≥5% was the second most significant predictor (behind baseline creatinine) of outcomes (Table). LVEF change ≥5% correlated with a modest increase in C-index compared to traditional predictors (Table). Conclusions: Serial evaluation for change ≥5% LVEF predicts both survival and HFH. Further validation of the incremental prognostic value of change in LVEF for important clinical decisions, including frequency of cardiac imaging, across various heart failure populations is needed.

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