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Cardiovascular MRI-derived Right Atrial Strain for Improved Risk Stratification in Patients with Severe Aortic
Torben Lange1, Bo Eric Beuthner1, Alexander Schulz1
1From the University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Strasse 40, 37075 Göttingen, Germany (T.L., B.E.B., A. Schulz, R.E., K.R.R., K.T., G.H., M.P., A. Schuster); German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany (T.L., B.E.B., A. Schulz, R.E., K.R.R., K.T., G.H., M.P., A. Schuster); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (A. Schulz); Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany (S.J.B.); German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany (S.J.B.); FORUM Radiology, Rosdorf, Germany (J.T.K.); Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany (G.H.); and FORUM Cardiology, Rosdorf, Germany (A. Schuster).
Cardiac MRI markers, including right atrial strain, predict cardiovascular death in severe aortic stenosis patients undergoing TAVR. These findings aid in optimizing patient management and risk assessment.
Area of Science:
- Cardiovascular Imaging
- Cardiac MRI
- Aortic Stenosis
Background:
- Severe aortic stenosis (AS) poses significant cardiovascular risks.
- Accurate prognostic assessment is crucial for guiding treatment decisions, particularly before transcatheter aortic valve replacement (TAVR).
- Cardiac magnetic resonance imaging (CMR) offers comprehensive assessment of cardiac structure and function.
Purpose of the Study:
- To evaluate the prognostic value of various cardiac MRI-derived imaging markers in severe AS patients.
- To identify specific CMR parameters that predict cardiovascular (CV) mortality in this population.
Main Methods:
- Prospective study of 145 severe AS patients undergoing CMR before TAVR.
- Analysis included myocardial volumes, feature-tracking-derived strain (atrial and ventricular), T1 mapping, and late gadolinium enhancement.
- Cox proportional hazards models assessed the association between CMR parameters and CV mortality.
Main Results:
- Patients experiencing CV death had significantly enlarged right ventricular (RV) volumes and impaired strain in all cardiac chambers.
- Right atrial (RA) reservoir strain emerged as an independent predictor of CV mortality (HR, 0.82; P = .008) after adjustment.
- In patients with high extracellular volume, RA strain further stratified CV mortality risk (P = .001).
Conclusions:
- Several cardiac MRI parameters are significantly associated with CV mortality in severe AS patients undergoing TAVR.
- Right atrial strain is a robust independent predictor of CV mortality.
- Incorporating RA strain into risk assessment may optimize patient management strategies.
