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Published on: May 28, 2019
Circumferential Strain Predicts Major Adverse Cardiovascular Events Following an Acute ST-Segment-Elevation
Kenneth Mangion1, David Carrick1, Jaclyn Carberry1
1From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.).
Insights
Circumferential left ventricular strain measured by cardiac MRI predicts major adverse cardiac events after ST-segment-elevation myocardial infarction. DENSE-derived strain offers incremental prognostic value beyond infarct size.
Area of Science:
- Cardiology
- Medical Imaging
- Prognostics
Background:
- Acute ST-segment-elevation myocardial infarction (STEMI) poses significant risks for major adverse cardiac events (MACE).
- Accurate prognostication is crucial for patient management following STEMI.
- Cardiac magnetic resonance imaging (MRI) offers advanced techniques for assessing myocardial function.
Purpose of the Study:
- To evaluate the prognostic capability of circumferential left ventricular (LV) strain, measured via cardiac MRI, in predicting MACE after STEMI.
- To compare different methods of strain measurement for their predictive accuracy.
Main Methods:
- Prospective enrollment of 259 participants with acute STEMI.
- Cardiac MRI at 1.5 T during hospitalization to assess circumferential LV strain using Displacement Encoding with Stimulated Echoes (DENSE) and feature tracking.
- Independent assessment of MACE during a median 4-year follow-up.
Main Results:
- DENSE-derived circumferential strain showed a higher predictive accuracy (AUC, 0.76) for MACE compared to feature tracking (AUC, 0.62; P = .03).
- DENSE strain's prognostic performance was comparable to initial infarct size and microvascular obstruction extent.
- DENSE-derived strain provided incremental prognostic benefit over infarct size for MACE prediction (hazard ratio, 1.3; P < .01).
Conclusions:
- Circumferential LV strain, particularly when measured by DENSE, is an independent prognostic indicator in patients post-STEMI.
- Cardiac MRI-derived strain assessment can enhance risk stratification for MACE in STEMI survivors.
- These findings support the integration of strain analysis into routine cardiac MRI protocols for STEMI patients.
Abstract:
Purpose To investigate the prognostic value of circumferential left ventricular (LV) strain measured by using cardiac MRI for prediction of major adverse cardiac events (MACE) following an acute ST-segment-elevation myocardial infarction (STEMI). Materials and Methods Participants with acute STEMI were prospectively enrolled from May 11, 2011, to November 22, 2012. Cardiac MRI was performed at 1.5 T during the index hospitalization. Displacement encoding with stimulated echoes (DENSE) and feature tracking of cine cardiac MRI was used to assess circumferential LV strain. MACE that occurred after discharge were independently assessed by cardiologists blinded to the baseline observations. Results A total of 259 participants (mean age, 58 years ± 11 [standard deviation]; 198 men [mean age, 58 years ± 11] and 61 women [mean age, 58 years ± 12]) underwent cardiac MRI 2.2 days ± 1.9 after STEMI. Average infarct size was 18% ± 13 of LV mass and circumferential strain was -13% ± 3 (DENSE method) and -24% ± 7 (feature- tracking method). Fifty-one percent (131 of 259 participants) had presence of microvascular obstruction. During a median follow-up period of 4 years, 8% (21 of 259) experienced MACE. Area under the curve (AUC) for DENSE was different from that of feature tracking (AUC, 0.76 vs 0.62; P = .03). AUC for DENSE was similar to that of initial infarct size (P = .06) and extent of microvascular obstruction (P = .08). DENSE-derived strain provided incremental prognostic benefit over infarct size for prediction of MACE (hazard ratio, 1.3; P < .01). Conclusion Circumferential strain has independent prognostic importance in study participants with acute ST-segment-elevation myocardial infarction. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Kramer in this issue.
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