The long-term predictive value of myocardial deformation measurement with cardiac magnetic resonance in acute myocardial infarction

Background Acute myocardial infarction (MI) is the main cause for developing heart failure (HF) (1). Reperfusion therapy with primary percutaneous coronary intervention (pPCI) has reduced mortality rate the last decades but approximately 30 % of patients will still develop ischemic adverse left ventricular remodelling (2,3). Cardiac magnetic resonance (CMR) is the gold standard method for assessment of left ventricular function and structure (4,5). Myocardial deformation measurement with feature tracking may be of help in identifying patients with increased mortality risk following acute MI. Purpose The aim of this seventeen to eighteen years follow-up study was to assess if myocardial deformation measurements can detect patients with increased all-cause mortality following acute MI. Methods Ninety-one patients that underwent pPCI due to acute MI between 2006 - 2007 were followed up with CMR imaging 4 to 8 weeks after the index event. CMR cine loops image acquisition, covering the left ventricle from base to apex via short axes images and standard apical 2-, 3- and 4 chambers views, were acquired with balanced state free precession sequences. MI scar was evaluated using late gadolinium enhancement. Cardiac deformation measurements were performed for global longitudinal strain (GLS), global radial strain (GRS) and for global circumferential strain (GCS) by tracking the left ventricular wall by a commercially free postprocessing software. Information about the clinical outcomes were collected from the national registry. Log Rank test was utilised to compute statistical significance determined to p < 0.05. Cox regression analysis was able to present adjusted hazard ratio (HR) with confidence intervals. The study was performed according to the Helsinki declaration for studies on humans and approved by the National Ethical Review authority (registration number: 2023-06484-01). Results CMR characteristics are presented in Table 1. Age adjusted GLS > - 14 % was associated with increased all-cause mortality risk (HR 2.2 CI 1.1 – 4.3, p < 0.05) while GCS was able to detect patients with increased risk of death already at > -17 %, (HR 2.2 CI 1.2-4.4, p < 0.05). When GRS cutoff value was set to < 27 %, age adjusted Cox regression analysis was able to detect patients with increased risk for all-cause death (HR 2.1 CI 1.1 – 4.0, p < 0.05). Conclusion Myocardial deformation analysis by feature tracking was able to identify patients with increased risk of all-cause mortality following acute MI. GLS > - 14 %, GRS < 27 % and GCS > -17 % were associated with a twofold increase in mortality risk.