Functional and prognostic implications of cardiac magnetic resonance feature tracking-derived remote myocardial strain analyses in patients following acute myocardial infarction

Abstract

Background Cardiac magnetic resonance myocardial feature tracking (CMR-FT)-derived global strain assessments provide incremental prognostic information in patients following acute myocardial infarction (AMI). Functional analyses of the remote myocardium (RM) are scarce and whether they provide an additional prognostic value in these patients is unknown. Methods 1034 patients following acute myocardial infarction were included. CMR imaging and strain analyses as well as infarct size quantification were performed after reperfusion by primary percutaneous coronary intervention. The occurrence of major adverse cardiac events (MACE) within 12 months after the index event was defined as primary clinical endpoint. Results Patients with MACE had significantly lower RM circumferential strain (CS) compared to those without MACE. A cutoff value for RM CS of − 25.8% best identified high-risk patients (p < 0.001 on log-rank testing) and impaired RM CS was a strong predictor of MACE (HR 1.05, 95% CI 1.07–1.14, p = 0.003). RM CS provided further risk stratification among patients considered at risk according to established CMR parameters for (1) patients with reduced left ventricular ejection fraction (LVEF) ≤ 35% (p = 0.038 on log-rank testing), (2) patients with reduced global circumferential strain (GCS) > − 18.3% (p = 0.015 on log-rank testing), and (3) patients with large microvascular obstruction ≥ 1.46% (p = 0.002 on log-rank testing). Conclusion CMR-FT-derived RM CS is a useful parameter to characterize the response of the remote myocardium and allows improved stratification following AMI beyond commonly used parameters, especially of high-risk patients. Trial registration ClinicalTrials.gov, NCT00712101 and NCT01612312 Graphic abstract Defining remote segments (R) in the presence of infarct areas (I) for the analysis of remote circumferential strain (CS). Remote CS was significantly lower in patients who suffered major adverse cardiac events (MACE) and a cutoff value for remote CS of − 25.8% best identified high-risk patients. In addition, impaired remote CS ≥ − 25.8 % (Remote −) and preserved remote CS < − 25.8 % (Remote +) enabled further risk stratification when added to established parameters like left ventricular ejection fraction (LVEF), global circumferential strain (GCS) or microvascular obstruction (MVO).

A head-to-head comparison of myocardial strain by fast-strain encoding and feature tracking imaging in acute myocardial infarction

“…FT is computed on cine-loops which are part of the standard balanced steady-state free precession (bSSFP) CMR examination ( 8 , 16 ). These segmented 2D cine-loops are acquired over the entire heart cycle, usually “averaged” from 5 to 10 heartbeats, which makes deformation measurement possible for each time step ( 6 , 16 , 20 ). Feature tracking (FT) uses either optical flow technology or non-rigid elastic registration ( 21 ).…”

Strain Analysis Using Feature Tracking Cardiac Magnetic Resonance Predict Prognosis of Patients With Ventricular Aneurysm After Myocardial Infarction

“…Segment strain analysis with CMR-FT in cardiac infarction predicts future cardiovascular events mortality over and above LV ejection fraction and infarct size 13,14 . A previous study have reported that GLS is an independent predictor of medium-term prognosis post STEMI 15 .…”

Quantification of Myocardial Deformation Applying CMR-Feature-Tracking—All About the Left Ventricle?

“…Importantly, by predicting ventricular arrhythmia or early myocardial remodelling very accurately [42,43], CMR-FT-based LV strain was found to outperform traditionally used LVEF in these studies further questioning current approaches using a LVEF cut of 35% for defibrillator device therapy and raising considerations of new risk classifications beyond this parameter. Of note, not only global LV strain analyses but also regional CMR-derived strain evaluations of non-infarcted remote myocardium were shown to allow an extended risk classification and categorise new high-risk groups in patients suffering AMI [44].…”