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Long-term Prognostic Value of Cardiac MRI Left Atrial Strain in ST-Segment Elevation Myocardial Infarction

Shuang Leng1, Heng Ge1, Jie He1

  • 1From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.).

Radiology
|June 17, 2020
PubMed

Insights

Left atrial strain, a measure of left atrial function, predicts long-term outcomes in ST-segment elevation myocardial infarction (STEMI) patients. Impaired reservoir and conduit strain indicate a higher risk of major adverse cardiac events (MACE).

Area of Science:

  • Cardiology
  • Medical Imaging
  • Prognostics

Background:

  • Left atrial (LA) dysfunction is linked to increased patient morbidity and mortality.
  • The prognostic value of LA strain in ST-segment elevation myocardial infarction (STEMI) patients for long-term outcomes remains largely unknown.

Purpose of the Study:

  • To prospectively evaluate left atrial strain as a predictor of long-term outcomes in patients following STEMI.
  • To assess the incremental prognostic value of LA strain beyond traditional risk factors in a multicenter cardiac MRI cohort.

Main Methods:

  • A prospective, multicenter cohort study (EARLY-MYO-CMR registry) included 321 STEMI patients treated with primary percutaneous coronary intervention.
  • Left atrial longitudinal strain and strain rate parameters were quantified using cardiac MRI.
  • Major adverse cardiac events (MACE), including cardiovascular death, myocardial reinfarction, heart failure hospitalization, and stroke, were tracked over a median of 3.7 years. Statistical analyses included time-dependent ROC, Kaplan-Meier, and multivariable Cox regression.

Main Results:

  • A total of 76 participants (23.7%) experienced MACE during follow-up.
  • Impaired LA reservoir strain (≤22%) and conduit strain (≤10%) were associated with a significantly higher risk of MACE (P < .001).
  • LA reservoir strain (HR, 0.84; P < .001) and conduit strain (HR, 0.81; P < .001) independently predicted MACE and provided incremental prognostic value over established risk factors (Uno C statistic 0.75 vs 0.68; P = .04).

Conclusions:

  • Left atrial strain assessment offers valuable prognostic information in STEMI patients.
  • LA strain parameters, specifically reservoir and conduit strain, enhance risk prediction beyond traditional factors, aiding in long-term outcome assessment.

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