Feature Tracking of Global Longitudinal Strain by Using                    Cardiovascular MRI Improves Risk Stratification in Heart Failure with Preserved                    Ejection Fraction

Kammerlander, Andreas A.; Donà, Carolina; Nitsche, Christian; Koschutnik, Matthias; Schönbauer, Robert; Duca, Franz; Zotter-Tufaro, Caroline; Binder, Christina; Aschauer, Stefan; Beitzke, Dietrich; Loewe, Christian; Hengstenberg, Christian; Bonderman, Diana; Mascherbauer, Julia

doi:10.1148/radiol.2020200195

Cited by 46 publications

(41 citation statements)

References 31 publications

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“…Our current analysis showed that CAD was independently associated with impaired GLS but not with GCS or GRS. This finding highlights the prognostic value of GLS in predicting cardiovascular events [ 25 ]. The association between CAD and impaired GLS in our study could provide evidence on why men appear more likely than women to have sudden cardiac death related to CAD [ 7 ].…”

Section: Discussionmentioning

confidence: 75%

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Effect of diabetes mellitus on the development of left ventricular contractile dysfunction in women with heart failure and preserved ejection fraction

Shi

Yang

Huang

et al. 2021

Cardiovasc Diabetol

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Background Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with sex-specific pathophysiology. Estrogen deficiency is believed to be responsible for the development of HFpEF in women. However, estrogen deficiency does not seem to be completely responsible for the differences in HFpEF prevalence between sexes. While diabetes mellitus (DM) frequently coexists with HFpEF in women and is associated with worse outcomes, the changes in myocardial contractility among women with HFpEF and the DM phenotype is yet unknown. Therefore, we aimed to investigate sex-related differences in left ventricular (LV) contractility dysfunction in HFpEF comorbid with DM. Methods A total of 224 patients who underwent cardiac cine MRI were included in this study. Sex-specific differences in LV structure and function in the context of DM were determined. LV systolic strains (global longitudinal strain [GLS], circumferential strain [GCS] and radial strain [GRS]) were measured using cine MRI. The determinants of impaired myocardial strain for women and men were assessed. Results The prevalence of DM did not differ between sexes (p > 0.05). Despite a similar LV ejection fraction, women with DM demonstrated a greater LV mass index than women without DM (p = 0.023). The prevalence of LV geometry patterns by sex did not differ in the non-DM subgroup, but there was a trend toward a more abnormal LV geometry in women with DM (p = 0.072). The magnitudes of systolic strains were similar between sexes in the non-DM group (p > 0.05). Nevertheless, in the DM subgroup, there was significant impairment in women in systolic strains compared with men (p < 0.05). In the multivariable analysis, DM was associated with impaired systolic strains in women (GLS [β = 0.26; p = 0.007], GCS [β = 0.31; p < 0.001], and GRS [β = −0.24; p = 0.016]), whereas obesity and coronary artery disease were associated with impaired systolic strains in men (p < 0.05). Conclusions Women with DM demonstrated greater LV contractile dysfunction, which indicates that women with HFpEF comorbid with DM have a high-risk phenotype of cardiac failure that may require more aggressive and personalized medical treatment.

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Section: Discussionmentioning

confidence: 75%

“…In terms of HFpEF, strain analysis allows the detection of systolic dysfunction in the absence of an overt reduction in LVEF and shows prognostic value in predicting adverse outcomes [ 24 , 25 ]. However, available data regarding the sex-related impact of coexisting DM on LV contractility in patients with HFpEF remain limited.…”

Section: Discussionmentioning

confidence: 99%

Effect of diabetes mellitus on the development of left ventricular contractile dysfunction in women with heart failure and preserved ejection fraction

Shi

Yang

Huang

et al. 2021

Cardiovasc Diabetol

View full text Add to dashboard Cite

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“…Heart failure (HF) with preserved ejection fraction (HFpEF) is as prevalent as HF with reduced ejection fraction (HFrEF) [ 1 – 4 ]; the prognosis of HFpEF is poor, similar to that of HFrEF [ 1 , 5 ]. The prevalence of HFpEF will continue to increase as life expectancy increases [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular magnetic resonance assessment of coronary flow reserve improves risk stratification in heart failure with preserved ejection fraction

Kato

Fukui

Kodama

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Coronary microvascular dysfunction (CMD) has been proposed as a novel mechanism for the pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF). Recent studies have suggested the potential utility of coronary flow reserve (CFR) as a marker of CMD in patients with HFpEF. Phase contrast (PC) cine cardiovascular magnetic resonance (CMR) of the coronary sinus has emerged as a non-invasive method to quantify CFR. We aimed to investigate the prognostic value of CMR-derived CFR in patients with HFpEF. Methods Data from 163 HFpEF patients (73 ± 9 years; 86 [53%] female) were retrospectively analyzed. Coronary sinus blood flow was measured in all patients, and myocardial blood flow was calculated as coronary sinus blood flow divided by left ventricular mass. CFR was calculated as the myocardial blood flow during adenosine triphosphate infusion divided by that at rest. Adverse events were defined as all-cause death and hospitalization due to HF exacerbation. Event-free survival stratified according to CFR < 2.0 was estimated with Kaplan–Meier survival methods and Log-rank test. Results During a median follow-up of 4.1 years, 26 patients (16%) experienced adverse events. CMR-derived CFR was significantly lower in HFpEF with adverse events compared with those without (1.93 ± 0.38 vs. 2.67 ± 0.52, p < 0.001). On a Kaplan Meier curve, the rates of adverse events were significantly higher in HFpEF patients with CFR < 2.0 compared with HFpEF with CFR ≥ 2.0 (p < 0.001). The area under the curve of CFR for predicting adverse events was significantly higher than that of LGE (0.881 vs. 0.768, p = 0.037) and GLS (0.881 vs. 0.747, p = 0.036). Conclusions CFR assessed using coronary sinus PC cine CMR may be useful as a non-invasive prognostic marker for HFpEF patients.

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“…GLS can detect subtle changes in the myocardium after infarction, thereby more accurately assessing systolic function and providing additional prognostic information [21][22][23]. A considerable number of STEMI patients have undergone PCI, and their LVEF is close to normal or may even remain unchanged; consequently, they are considered low-risk patients [24].…”

Section: Discussionmentioning

confidence: 99%

Value of TIMI Risk Score Combined With Global Longitudinal Strain for Predicting Major Adverse Cardiac Events After PCI in Patients With ST-Segment Elevation Myocardial Infarction

Yang

Wang

Zhu

et al. 2021

Preprint

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PurposeAccurately assessing the predicting prognosis is important in ST-segment elevation myocardial infarction (STEMI). This study aimed to investigate the predictive value of the TIMI risk score combined with GLS for the occurrence of major adverse cardiovascular events (MACEs)in STEMI patients after percutaneous coronary intervention (PCI)MethodsAcute STEMI diagnosed between January 2019 to June 2021 were prospectively enrolled. GLS were performed to assess left ventricular dysfunction three days post-percutaneous coronary intervention (PCI). In a 12-month follow up, three prognostic models for MACE were established based on TIMI risk score alone, TIMI risk score + GLS, and TIMI risk score + GLS + clinical risk factors, respectively, and assessed for efficiency.ResultsA total of 138 patients were enrolled. According to the follow-up results, the incidence of MACE in the patients was 19.6% (27/138). Areas under the receiver operating characteristic (ROC) curves were 0.703, 0.810 and 0.815, respectively, in TIMI risk score alone, TIMI risk score + GLS, TIMI risk score + GLS + clinical risk factors, indicating a significantly higher value and more efficient assessment for TIMI risk score + GLS.ConclusionCompared with the TIMI risk score alone, TIMI risk score combined with GLS provides a more efficient assessment of risk for determining the prognosis of STEMI patients.

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Feature Tracking of Global Longitudinal Strain by Using Cardiovascular MRI Improves Risk Stratification in Heart Failure with Preserved Ejection Fraction

Cited by 46 publications

References 31 publications

Effect of diabetes mellitus on the development of left ventricular contractile dysfunction in women with heart failure and preserved ejection fraction

Effect of diabetes mellitus on the development of left ventricular contractile dysfunction in women with heart failure and preserved ejection fraction

Cardiovascular magnetic resonance assessment of coronary flow reserve improves risk stratification in heart failure with preserved ejection fraction

Value of TIMI Risk Score Combined With Global Longitudinal Strain for Predicting Major Adverse Cardiac Events After PCI in Patients With ST-Segment Elevation Myocardial Infarction

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