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

Abstract

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.

Feature-Tracking Strain Parameters Differ Between Highly Accelerated and Conventional Acquisitions

“…GRS was the strain parameter with the highest range of variance and also the only parameter showing significant bias from pooled medians. This is in line with previous studies, which already identified GRS as the least robust parameter 9 …”

“…Strain imaging and global longitudinal strain (GLS) in particular have since been analyzed in multiple studies to evaluate the prognosis for ischemic as well as nonischemic cardiomyopathies. [6][7][8][9][10] However, as the foundation (ie, the cine sequences) evolved, the postprocessing algorithms had to be constantly reevaluated. Previous single-software studies have shown an excellent correlation between FT-strain values derived from Cine and CS sequences; however, most studies revealed a consistent underestimation of CS-derived strain values.…”

Different Impacts on the Heart After COVID-19 Infection and Vaccination: Insights From Cardiovascular Magnetic Resonance

“…It has been shown that strain assessment by FT correlates significantly with the ECV burden in patients with non-ischemic cardiomyopathies ( 37 ), potentially being a non-contrast dependent tissue marker for myocardial fibrosis. Strain values can also aid in risk stratification with decreased strain values being associated with worse outcomes ( 38 , 39 ). Similar results have been observed by the application of strain-encoded magnetic resonance (SENC) tagging acquisitions ( 40 ).…”

“…A total of 162 patients were recruited of whom 141 could be included for analysis (median age [interquartile range (IQR)], 45 (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56); 83 women; 34/141 sCov, 43 (37-52); 19 women; 63/141 pCov, 52 (39-58); 43 women; 44/141 CovVac, 43 (32-56), 23 men; and 44 HC, 41 (28-52); 24 women; Table 1).…”

“…The median age in years (interquartile range (IQR)) of the entire cohort was 45 (37-56) which included 83 women and 58 men. Subgroups were as follows (total patients per subgroup, median age in years (IQR), main gender): 34 sCov, 43 (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52) 19 women; 63 pCov,(52)(53)(54)(55)(56)(57)(58) 43 women; 44 CovVac,(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56) 23 men;(44)(45)(46)(47)(48)(49)(50)(51)(52), 24 women). The biventricular function was preserved and revealed no differences between the groups.…”