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Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
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Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral

Stephan M Pio1, Diego Medvedofsky2, Jan Stassen1,3

  • 1Department of Cardiology Leiden University Medical Center Leiden the Netherlands.

Journal of the American Heart Association
|August 30, 2023
PubMed

Insights

Improving left ventricular global longitudinal strain (GLS) in heart failure patients with mitral regurgitation is linked to better outcomes. This prognostic marker shows improvement after transcatheter repair or guideline-directed therapy alone.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Heart Failure Management

Background:

  • Left ventricular (LV) global longitudinal strain (GLS) offers prognostic value beyond ejection fraction in heart failure (HF) with secondary mitral regurgitation.
  • Assessing the impact of LV GLS improvement is crucial for understanding treatment efficacy in this patient group.

Purpose of the Study:

  • To evaluate the prognostic significance of LV GLS improvement from baseline to six months in patients with HF and severe mitral regurgitation.
  • To determine if LV GLS improvement predicts outcomes in patients treated with transcatheter edge-to-edge repair plus guideline-directed medical therapy (GDMT) versus GDMT alone.

Main Methods:

  • The COAPT trial randomized 383 symptomatic HF patients with severe mitral regurgitation to MitraClip device plus GDMT or GDMT alone.
  • LV GLS was measured at baseline and six months. The association between GLS improvement and the composite of death or HF hospitalization from six to 24 months was analyzed.

Main Results:

  • 174 patients (45.4%) showed improved LV GLS at six months, with no significant difference between treatment groups (42.6% vs. 48.4%, P=0.25).
  • LV GLS improvement was strongly associated with a reduced risk of death or HF hospitalization between six and 24 months (P<0.009).
  • Multivariable analysis confirmed LV GLS improvement as an independent predictor of lower risk for death or HF hospitalization (HR, 0.55; P=0.009).

Conclusions:

  • Improvement in LV GLS at six months is associated with better clinical outcomes in patients with HF and severe mitral regurgitation.
  • This association holds true regardless of whether patients received transcatheter edge-to-edge repair or GDMT alone.
  • LV GLS is a valuable prognostic indicator in this complex HF population.

Keywords:
COAPT trialheart failureleft ventricular global longitudinal strainsecondary mitral regurgitationtranscatheter edge‐to‐edge repair

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