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Updated: Jan 15, 2026
Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
Published on: February 12, 2011
Feature Tracking-Derived Global Longitudinal Strain Enhances Risk Stratification for Sudden Cardiac Death in
Xuan Ma1, Yun Tang1, Xingrui Chen1
1Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Left ventricular global longitudinal strain (LV-GLS) measured by cardiac magnetic resonance (CMR) is an independent predictor of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). LV-GLS improves risk stratification beyond current models and mediates the link between myocardial issues and SCD.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Biomarkers
Background:
- Left ventricular global longitudinal strain (LV-GLS) by cardiac magnetic resonance (CMR) is an emerging marker for adverse outcomes in hypertrophic cardiomyopathy (HCM).
- Its incremental prognostic value and role in sudden cardiac death (SCD) risk stratification in HCM are not fully understood.
Purpose of the Study:
- To assess if LV-GLS provides prognostic value beyond existing European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) SCD risk models in HCM.
- To determine if LV-GLS mediates the relationship between myocardial abnormalities and SCD risk in HCM patients.
Main Methods:
- Retrospective analysis of 2,009 HCM patients who underwent CMR.
- LV-GLS quantified using CMR feature tracking; primary endpoint was SCD or aborted SCD.
- Prognostic performance evaluated using time-dependent ROC analysis and competing risk regression; mediation analysis explored LV-GLS's role between myocardial factors and SCD.
Main Results:
- Lower absolute LV-GLS values were observed in patients who experienced SCD (9.0% vs 11.1%).
- LV-GLS independently predicted SCD, improving the 5-year predictive accuracy of ESC and ACC/AHA models (AUC increased from 0.72 to 0.77 and 0.71 to 0.76, respectively).
- LV-GLS partially mediated the association between maximum wall thickness (17.5%) and fibrosis extent (23.1%) and SCD risk.
Conclusions:
- CMR-derived LV-GLS is an incremental predictor of SCD in HCM patients, surpassing current guideline-based risk models.
- LV-GLS plays a partial mediating role in the link between myocardial abnormalities (hypertrophy, fibrosis) and SCD risk.
Background:
Left ventricular (LV)-global longitudinal strain (GLS) assessed by cardiac magnetic resonance (CMR) feature tracking is an emerging marker for predicting adverse outcomes in hypertrophic cardiomyopathy (HCM), but its incremental prognostic value and mechanistic role in sudden cardiac death (SCD) risk stratification remain unclear.
Objectives:
The study sought to evaluate whether LV-GLS adds prognostic value beyond current ESC (European Society of Cardiology) and ACC (American College of Cardiology)/AHA (American Heart Association) SCD risk models, and mediates the relationship between myocardial abnormalities and SCD risk in HCM.
Methods:
The authors retrospectively analyzed 2,009 patients with HCM (mean age: 50 ± 14 years, 70% men) who underwent CMR between 2010 and 2017. LV-GLS was quantified using cine CMR feature tracking. The primary endpoint included SCD and aborted SCD. Prognostic performance was assessed using time-dependent receiver-operating characteristic analysis and competing risk regression. Mediation analysis was used to investigate how LV-GLS mediated associations between myocardial hypertrophy, fibrosis, and SCD.
Results:
Over a median follow-up of 88.2 months, 85 (4.2%) patients experienced SCD events. These patients had significantly lower absolute LV-GLS values (9.0% ± 3.6% vs 11.1% ± 3.6%; P < 0.001). In competing-risk regression, LV-GLS independently predicted SCD after adjustment for ESC (subdistribution HR [sHR]: 1.12 per 1% decrease [95% CI: 1.06-1.22]; P < 0.001) and ACC/AHA risk factors (sHR: 1.09 [95% CI: 1.02-1.18]; P = 0.016). Adding LV-GLS improved the 5-year predictive accuracy of both ESC and ACC/AHA models (AUC from 0.72 to 0.77 and from 0.71 to 0.76, respectively). Absolute LV-GLS with a cutoff of 9.23% further stratified risk in patient subgroups with either class II or class III implantable cardioverter-defibrillator indications (all log-rank P < 0.001). Mediation analysis showed LV-GLS partially mediated the effect of maximum wall thickness and extent of fibrosis on SCD (proportion-mediated: 17.5% and 23.1%, respectively; both P < 0.001).
Conclusions:
In patients with HCM, CMR-derived LV-GLS is an incremental predictor of SCD beyond current guideline-based risk models and partially mediates the association between myocardial abnormalities and SCD.
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