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Left Ventricular Longitudinal Dyssynchrony by CMR Feature Tracking Is Related to Adverse Prognosis in Advanced

Yanyan Song1, Lu Li2, Xiuyu Chen1

  • 1Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Frontiers in Cardiovascular Medicine
|October 28, 2021
PubMed

Insights

Left ventricular longitudinal dyssynchrony (LVLD) measured by cardiovascular magnetic resonance-feature tracking (CMR-FT) predicts adverse outcomes in arrhythmogenic cardiomyopathy (ACM) patients with right ventricular dysfunction. Elevated LVLD is an independent risk factor for cardiovascular and arrhythmic events, aiding prognosis.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biomedical Engineering

Background:

  • Arrhythmogenic cardiomyopathy (ACM) is characterized by right ventricular (RV) dysfunction, but left ventricular (LV) involvement significantly impacts prognosis.
  • Accurate assessment of LV mechanics is crucial for risk stratification in ACM patients, especially those with coexisting RV dysfunction.

Purpose of the Study:

  • To evaluate left ventricular (LV) mechanics using cardiovascular magnetic resonance-feature tracking (CMR-FT) in arrhythmogenic cardiomyopathy (ACM) patients with right ventricular (RV) dysfunction.
  • To determine the prognostic value of LV mechanical parameters, specifically LV longitudinal dyssynchrony (LVLD), for cardiovascular and arrhythmic events.

Main Methods:

  • Retrospective analysis of 89 ACM patients diagnosed by revised Task Force Criteria (rTFC).
  • Cardiovascular magnetic resonance (CMR) examinations including LV and RV strain and dyssynchrony analysis via feature tracking (FT).
  • Follow-up assessment for composite cardiovascular events (arrhythmic events and heart transplantation) and secondary outcome of arrhythmic events.

Main Results:

  • Patients experiencing cardiovascular events showed impaired LV global longitudinal strain, impaired LV global circumferential strain, and greater LV longitudinal dyssynchrony (LVLD).
  • LVLD emerged as a significant predictor, with LVLD ≥89.15 ms being an independent risk factor for both cardiovascular events (HR: 4.50) and arrhythmic events (HR: 4.79) after multivariable adjustment.
  • The study identified specific thresholds for impaired LV strain and elevated LVLD associated with adverse outcomes in this cohort.

Conclusions:

  • Left ventricular longitudinal dyssynchrony (LVLD), assessed by CMR-FT, is an independent predictor of adverse cardiovascular and arrhythmic events in advanced ACM.
  • CMR-FT derived LVLD provides valuable prognostic information for stratifying risk in ACM patients with coexisting RV dysfunction.
  • This quantitative imaging biomarker can aid clinicians in identifying high-risk ACM patients requiring closer monitoring and potentially earlier intervention.

Keywords:
arrhythmogenic cardiomyopathydyssynchronyfeature trackingmagnetic resonance imagingprognosis

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