Extracellular Volume and Global Longitudinal Strain Both Associate With Outcomes But Correlate Minimally

Fröjdh, Fredrika; Fridman, Yaron; Bering, Patrick; Sayeed, Aatif; Maanja, Maren; Niklasson, Louise; Olausson, Eric; Pi, Hongyang; Azeem, Ali A.; Wong, Timothy C.; Kellman, Peter; Feingold, Brian; Christopher, Adam; Fukui, Miho; Cavalcante, João L.; Miller, Chris; Butler, Javed; Ugander, Martin; Schelbert, Erik B.

doi:10.1016/j.jcmg.2020.04.026

Cited by 46 publications

(42 citation statements)

References 29 publications

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“…A few small studies that investigated relationships between strain and ECV [ 10 , 11 , 13 , 14 ] yielded mixed findings largely due to small sample size and/or narrow span of ECV distribution. A recently published large study also reported a lack of linear correlation between ECV and GLS [ 3 ]. In the present report we found that there is an important relationship between tissue features characterized by ECV, native and post-contrast T1, and strain indices including longitudinal, circumferential and radial strains.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Increased extracellular volume fraction (ECV), assessed by cardiovascular magnetic resonance imaging (CMR), is a valuable surrogate of myocardial fibrosis burden and is associated with adverse clinical outcomes [ 1 – 3 ]. Left ventricular (LV) global longitudinal strain (GLS), an index of mechanical performance is also a robust predictor of outcome risk [ 3 – 5 ]. However, it remains unclear how tissue property alteration assessed by ECV is related to myocardial mechanical change evaluated by strain, not only in the longitudinal direction, but also in the circumferential and radial directions, in clinical cohorts with diverse etiologies and how they collectively impact adverse clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The association of reduced left ventricular strains with increased extracellular volume and their collective impact on clinical outcomes

Jin

Weber

Singh

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Myocardial fibrosis and left ventricular (LV) longitudinal strain are independently associated with adverse clinical outcomes. However, the relationship between tissue properties and strain indices as well as their collective impact on outcomes are yet to be fully elucidated. We aim to investigate the relationship between LV global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) with extracellular volume (ECV) and their collective impact. Methods Consecutive patients referred for clinical cardiovascular magnetic resonance (CMR) due to cardiomyopathy were prospectively enrolled. All patients underwent CMR with T1 mapping. ECV was calculated incorporating native and post-contrast T1 as well as hematocrit. LV GLS, GCS, and GRS were assessed by feature tracking. Hazard ratios and Kaplan–Meier curves were produced to assess the association between strains and T1 mapping indices with a composite outcome of all-cause mortality and hospitalized heart failure. Results The study consisted of 259 patients with mixed referring diagnoses of non-ischemic/ischemic cardiomyopathy and 21 normal controls. Decreased GLS, GCS and GRS were associated with increased ECV, increased native T1, and reduced post-contrast T1 in a dose dependent manner when T1 or ECV was in the abnormal range. After a mean follow-up of 31 ± 23 months, 41 events occurred including 37 heart failure admissions and 4 deaths. Kaplan–Meier plots demonstrated that reduced strains were associated with reduced event-free survival predominantly in patients with increased ECV (≥ 28.3%). The worst outcome was among those with both reduced strains and increased ECV. In the multivariable models, increased ECV, reduced post-contrast T1 and reduced strains in all 3 directions remained predictors of outcome risk, respectively. Conclusion Our findings highlight the intrinsic link between altered CMR tissue properties and impaired myocardial mechanical performance and additionally demonstrate improved risk stratification by characterizing tissue property among patients with reduced strain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The association of reduced left ventricular strains with increased extracellular volume and their collective impact on clinical outcomes

Jin

Weber

Singh

et al. 2021

Journal of Cardiovascular Magnetic Resonance

View full text Add to dashboard Cite

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“…Especially the determination of GLS is of additional prognostic value because a worsening of GLS has been associated with higher mortality even in patients with preserved ejection fraction [12][13][14][21][22][23][24]. In a recent study by Fröjdh et al of consecutive adult patients who were referred to their center for standard CMR, a GLS > − 16% was associated with a higher mortality [25]. None of our patients had a GLS > − 16%.…”

Section: Discussionmentioning

confidence: 50%

Myocardial strain analysis using cardiac magnetic resonance in patients with calpainopathy

Quick

Winkler

Speiser

et al. 2021

Orphanet J Rare Dis

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Background Limb–girdle muscular dystrophy (LGMD) is a genetically and clinically heterogeneous group of rare muscular dystrophies. Subtype 2A (LGMD2A) also known as “calpainopathy” is an inherited autosomal recessive gene defect. Cardiac dysfunction is common in several forms of LGMD. Cardiac involvement in LGMD2A, however, is not clear. The aim of this study was to perform cardiac magnetic resonance (CMR)-based strain analysis in LGMD2A patients, as this is a diagnostic parameter of subclinical cardiac involvement and a powerful independent predictor of mortality. We conducted the largest prospective cardiac magnetic resonance study to date, including 11 genetically verified LGMD2A patients and 11 age- and sex-matched control subjects and performed CMR-based strain analysis of the left and right ventricles. Results Left and right global longitudinal strain (GLS) were not significantly different between the two groups and within normal reference ranges (left ventricle: control − 21.8 (5.1) % vs. patients − 22.3 (3.2) %, p = 0.38; right ventricle: control − 26.3 (7.2) % vs. patients − 26.8 (5.8) %, p = 0.85). Also, global circumferential and radial strains did not significantly differ between the two groups (p = 0.95 and p = 0.86, respectively). LGMD2A patients did not show relevant amounts of late gadolinium enhancement (LGE) or malignant ventricular arrhythmias. Conclusions No evidence of even subtle cardiac dysfunction is evident form CMR-based strain analysis in LGMD2A patients. Malignant ventricular arrhythmias were not detected. Thus, in case of non-pathological initial echocardiographic and electrocardiographic examination, a less frequent or even no cardiac follow-up may be acceptable in these patients. However, if there are signs and symptoms that suggest an underlying cardiac condition (e.g. palpitations, angina, shortness of breath), this approach needs to be individualized to account for the unknown.

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“…Previous experimental study by Kramann et al [38] reported that strain parameters not only detected LV contractile abnormalities but also correlated with the severity of interstitial myocardial brosis and hypertrophy in rat models with uremic cardiomyopathy. On the other hand, in a recent clinical study, Frojdh et al [39] demonstrated that myocardial interstitial brosis assessed by expansion of extracellular volume fraction (ECV) and GLS were both associated with outcomes, but they correlated minimally, suggesting that diffuse myocardial interstitial expansion and contractile dysfunction may re ect different domains of myocardium disease.…”

Section: Discussionmentioning

confidence: 99%

Feature-Tracking Left Ventricular Global Longitudinal Strain Improves 6 Months After Kidney Transplantation Associated With Reverse Remodeling, Not Myocardial Tissue Characteristics

Barbosa

Contti

Andrade

et al. 2021

Preprint

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PurposeTo determine whether left ventricular (LV) global longitudinal strain (GLS) measured by feature-tracking (FT) cardiac magnetic resonance (CMR) improves after kidney transplantation (KT) and to analyze associations between LV GLS, reverse remodeling, and myocardial tissue characteristics.MethodsThis is a prospective single-center cohort study of kidney transplant recipients who underwent two CMR examinations in a 3T scanner, including cines, tagging, T1 and T2 mapping. The baseline exam was done until 10 days after transplantation and the follow-up after 6 months. Age and sex-matched healthy controls were also studied for comparison. ResultsA total of 44 patients (mean age 50 ± 11 years-old, 27 (61.4%) male) completed the two CMR exams. LV GLS improved from -13.4% +/- 3.0 at baseline to -15.2% +/- 2.7 at follow-up (p < 0.001), but remained impaired when compared with controls (-17.7% +/- 1.5, p = 0.007). We observed significant correlation between improvement in LV GLS with reductions of left ventricular mass index (r = 0.356, p= 0.018). Improvement in LV GLS paralleled improvements in LV stroke volume index (r = -0.429, p = 0.004), ejection fraction (r = -0.408, p = 0.006), global circumferential strain (r = 0.420, p = 0.004) and global radial strain (r = -0.530, p = 0.002). There were no significant correlations between LV GLS, native T1 or T2 measurements (p > 0.05). ConclusionIn this study, we demonstrated that LV GLS measured by FT-CMR improves 6 months after KT in association with reverse remodeling, but not native T1 or T2 measurements.

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Extracellular Volume and Global Longitudinal Strain Both Associate With Outcomes But Correlate Minimally

Cited by 46 publications

References 29 publications

The association of reduced left ventricular strains with increased extracellular volume and their collective impact on clinical outcomes

The association of reduced left ventricular strains with increased extracellular volume and their collective impact on clinical outcomes

Myocardial strain analysis using cardiac magnetic resonance in patients with calpainopathy

Feature-Tracking Left Ventricular Global Longitudinal Strain Improves 6 Months After Kidney Transplantation Associated With Reverse Remodeling, Not Myocardial Tissue Characteristics

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