The Rapid Long-axis Strain-based Prognostic Models Evaluate Composite Adverse Events for Asymptomatic...

Dextro-Transposition of the great arteries (d-TGA), the second most common cyanotic congenital heart defect, requires early risk stratification to identify high-risk arterial switch operation (ASO) patients for long-term prognosis. The aim of this study was to 1) determine biventricular strain and rapid long-axis strain (RLAS) could detect impaired biventricular mechanical in D-TGA patients and 2) establish and validate strain-based prognostic models for improved risk stratification and prediction of composite adverse events.

All patients with D-TGA were divided into training test set and external test set who underwent cardiovascular magnetic resonance (CMR) examination were included in the study. The composite adverse events were defined as complications that necessitated reintervention by echocardiography after CMR. Cardiac function and strain variables were initially considered for inclusion in three models. L1 regularization feature selection was constrained to a maximum of five variables. Its predictive performance was evaluated using the integrated area under the receiver operating characteristic curve (AUC).

This study recruited 52 patients in the training set and 20 in the external test set. The primary adverse events were observed in 22 patients (42.3%) and five patients (25%). Compared with controls, the training set patients had significantly greater right ventricle (RV) global circumferential strain (GCS) (-16.32±3.40 vs. -9.41±2.89, p <0.001) and RV GRS (26.93±7.49 vs. 15.03±5.02, p < 0.001) and had significantly reduced left ventricle (LV) atrioventricular junction longitudinal strain (AJLS) (-17.32±3.62 vs. -19.87±2.93, p = 0.033). LV AJLS >18% had significant risk stratification of experiencing composite adverse events (p = 0.004) in the training set group. The model 3 yielded higher diagnostic performance than the other models (AUC=0.87,95% CI:0.83,0.93) in the training set. The model 3 (AUC=0.91, 95% CI:0.87,0.92) integrating biventricular strain and RLAS demonstrated excellent prognostic performance compared with model 1 (AUC=0.71, 95% CI:0.66,0.74) and model 2(AUC=0.67, CI:0.62,0.74) in external set group.

LV AJLS and RV GCS were found to be independent predictors of composite adverse events. LV AJLS had significant risk stratification of experiencing composite adverse events. The model integrating biventricular strain and RLAS demonstrated excellent prognostic performance compared with traditional models in asymptomatic D-TGA patients.