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Long-term prognostic value of left and right ventricular systolic function on cardiovascular magnetic resonance
Parag Bawaskar1, Sanya Chhikara1, Yugene Guo1
1Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA.
Insights
In systemic sclerosis (SSc) patients, impaired left and right ventricular global longitudinal strain (GLS) detected by cardiovascular magnetic resonance (CMR) predict long-term adverse cardiac events, unlike ejection fraction (EF). This highlights GLS as a key prognostic marker.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Systemic sclerosis (SSc) is a rare autoimmune disease with a high risk of cardiovascular complications.
- Cardiac involvement in SSc significantly impacts patient prognosis.
- Early detection of cardiac dysfunction is crucial for managing SSc patients.
Purpose of the Study:
- To evaluate the long-term prognostic value of left ventricular (LV) and right ventricular (RV) systolic dysfunction in SSc patients.
- To determine if cardiovascular magnetic resonance (CMR) measures of LV and RV function, specifically ejection fraction (EF) and global longitudinal strain (GLS), are associated with long-term outcomes.
- To identify reliable imaging biomarkers for predicting major adverse cardiac events (MACE) in SSc.
Main Methods:
- Retrospective cohort study of 151 adult SSc patients with suspected cardiac disease who underwent CMR.
- Assessment of LV and RV function using ejection fraction (EF) and feature tracking-derived global longitudinal strain (GLS).
- Long-term follow-up to determine the incidence of a composite endpoint of death or MACE.
Main Results:
- Worse LV global longitudinal strain (GLS) was independently associated with an increased risk of death or MACE (HR 1.08 per 1% worsening; P=0.018).
- Worse RV global longitudinal strain (GLS) was also independently associated with the composite endpoint (HR 1.08 per 1% worsening; P=0.017).
- Neither left ventricular ejection fraction (LVEF) nor right ventricular ejection fraction (RVEF) showed a significant association with the long-term composite endpoint.
Conclusions:
- In SSc patients with suspected cardiac disease, impaired LVGLS and RVGLS on CMR are significant independent predictors of long-term mortality and MACE.
- Global longitudinal strain (GLS) is a more sensitive prognostic marker than ejection fraction (EF) for cardiac dysfunction in SSc.
- CMR-derived GLS can aid in risk stratification and management of cardiovascular complications in systemic sclerosis.
Aims:
Systemic sclerosis (SSc) is a rare autoimmune disorder associated with a high risk of cardiovascular diseases. We aimed to determine the long-term prognostic value of left and right ventricular (LV and RV) systolic dysfunction in SSc patients with clinically suspected cardiac disease.
Methods And Results:
We conducted a retrospective cohort study of consecutive adults with SSc who had cardiovascular magnetic resonance (CMR) imaging for suspected cardiac disease. We assessed two CMR measures of LV and RV function, ejection fraction (EF), and feature tracking-derived global longitudinal strain (GLS) and investigated their associations with the long-term incidence of a composite endpoint of death or major adverse cardiac events (MACE). In 151 patients (median age 58 years, 81% women) who had CMR at a median of 3.6 years after diagnosis, the median LVEF was 58.0%, and the median LVGLS was -15.7%. The median RVEF was 57.0%, and the median RVGLS was -16.2%. Over a median follow-up of 4.7 years, 69 patients experienced the composite endpoint of death or MACE. LVGLS was independently associated with the composite endpoint [hazard ratio (HR) 1.08 per 1% worsening; 95% confidence interval (CI) 1.01-1.15; P = 0.018], while LVEF was not. Similarly, RVGLS was independently associated with the composite endpoint (HR 1.08 per 1% worsening; 95% CI 1.01-1.15; P = 0.017), while RVEF was not.
Conclusion:
In patients with SSc and clinically suspected cardiac disease, worse LVGLS and RVGLS on CMR were independently associated with death or MACE, while LVEF and RVEF were not.
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