June 16, 2020RadiologyOpen Access

Long-term Prognostic Value of Cardiac MRI Left Atrial Strain in ST-Segment Elevation Myocardial Infarction

Q: What are the key findings of this study?

Cardiac MRI-derived left atrial reservoir strain (HR 0.84) and conduit strain (HR 0.81) independently predicted major adverse cardiac events after ST-segment elevation myocardial infarction.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: ST-segment elevation myocardial infarction (STEMI) (n=321). Intervention: Cardiac MRI left atrial reservoir strain vs. Traditional outcome markers (LA volume, LV function). Primary outcome: Major adverse cardiac events (MACE) (HR 0.84, 95% CI 0.77-0.91, p=<0.001).

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Key result

Cardiac MRI left atrial reservoir strain predicts ~16% lower MACE risk after STEMI.

HR 0.84
95% CI 0.77-0.91
P<0.001
n=321

Why the study?

Does cardiac MRI-derived left atrial strain predict long-term major adverse cardiac events in patients with ST-segment elevation myocardial infarction?

Population

321 adults with their first ST-segment elevation myocardial infarction who underwent primary percutaneous…

Comparison

Assessment of left atrial longitudinal strain… vs Traditional cardiac MRI risk factors and outcome…

Design

Cohort, MRI readers blinded to patient characteristics, follow-up information…

Follow-up

median 3.7 years (44 months)

Authors

SLShuang LengCardiac Imaging HGHeng GeMinistry of Education of the People's Republic of China JHJie HeAcademy of Medical Sciences

Discussion

Member takes

Implication

May refine post-STEMI risk stratification on routine CMR; hypothesis-generating and requires prospective validation before practice change.

Study Design

Type

Cohort (n=321)

Multicenter

Yes

Structured PICO

Does cardiac MRI-derived left atrial strain predict long-term major adverse cardiac events in patients with ST-segment elevation myocardial infarction?

Population

321 adults (median age 59 years, 90% men) with their first ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention and cardiac MRI within 1 week of symptom onset, and had sinus rhythm during MRI acquisition.

Intervention

Assessment of left atrial (LA) longitudinal strain (reservoir and conduit strain) derived from standard cine cardiac MRI using a fast semi-automated method.

Comparator

Traditional cardiac MRI risk factors and outcome predictors (including LVEF, LV mass index, LV global longitudinal strain, infarct size, and maximal LA volume index).

Outcome

Major adverse cardiac events (MACE), defined as a composite of cardiovascular death, myocardial re-infarction, hospitalization for heart failure, and stroke, assessed at a median follow-up of 3.7 years.composite

Main Result

Effect estimate: HR 0.84 (95% CI 0.77-0.91)

p-value: p=<0.001

Left atrial strain derived from routine cine cardiac MRI provides independent and incremental long-term prognostic information beyond traditional left ventricular metrics and infarct size in patients recovering from STEMI.

Limitations

Cardiac MRI data were acquired during the first 3 to 7 days after STEMI rather than at a single exact time point.
The cut-offs of abnormal reservoir (21.8%) and conduit (10.5%) strains obtained from time-dependent ROC analysis may not represent the ground truth.
Heart rate differed between groups with and without MACE.
Cardiac MRI data were acquired during the first 3 to 7 days after STEMI rather than at a single exact time point
The cut-off of abnormal reservoir (21.8%) and conduit (10.5%) strains obtained from time-dependent ROC analysis of the 321 participants may not represent the ground truth, which should ideally be derived from large normal populations

Cite This Study

Leng et al. (2020) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=321). Cardiac MRI left atrial reservoir strain vs. Traditional outcome markers (LA volume, LV function) was evaluated on Major adverse cardiac events (MACE) (HR 0.84, 95% CI 0.77-0.91, p=<0.001). Cardiac MRI-derived left atrial reservoir strain (HR 0.84) and conduit strain (HR 0.81) independently predicted major adverse cardiac events after ST-segment elevation myocardial infarction.

synapsesocial.com/papers/6a15d3cfcaf7e3ea0ee3bfce https://doi.org/10.1148/radiol.2020200176

Topics

STEMI management

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Implication

May refine post-STEMI risk stratification on routine CMR; hypothesis-generating and requires prospective validation before practice change.

Long-term Prognostic Value of Cardiac MRI Left Atrial Strain in ST-Segment Elevation Myocardial Infarction

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Long-term Prognostic Value of Cardiac MRI Left Atrial Strain in ST-Segment Elevation Myocardial Infarction

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider