Key result
Every 1% increase in left atrial conduit strain (LAεe) was associated with a reduced risk of major adverse cardiac events (HR 0.74) in patients with dilated cardiomyopathy.
Why the study?
Despite the use of CMR feature tracking imaging to detect myocardial deformation, the optimal strain index in DCM was unclear.
Does CMR-FT derived left atrial conduit strain (LAεe) provide incremental prognostic value for major adverse cardiac events in patients with dilated cardiomyopathy?
Cohort (n=412)
No
Does CMR-FT derived left atrial conduit strain (LAεe) provide incremental prognostic value for major adverse cardiac events in patients with dilated cardiomyopathy?
Hazard Ratio: 0.74 (95% CI 0.68–0.81)
p-value: p=<0.001
Left atrial conduit strain (LAεe) derived from CMR feature tracking provides superior and incremental prognostic value over biventricular strains and conventional clinical predictors in patients with dilated cardiomyopathy.
Despite the use of cardiovascular magnetic resonance (CMR) feature tracking (FT) imaging to detect myocardial deformation, the optimal strain index in dilated cardiomyopathy (DCM) is unclear. This study aimed to determine whether atrial and biventricular strains can provide the greatest or joint incremental prognostic value in patients with DCM over a long follow-up period. Four hundred-twelve DCM patients were included retrospectively. Comprehensive clinical evaluation and imaging investigations were obtained, including measurements of CMR-FT derived left atrial (LA) reservoir, conduit, booster strain (εs, εe, εa); left ventricular (LV) and right ventricular (RV) global longitudinal, radial, circumferential strain (GLS, GRS, GCS). All patients were followed up for major adverse cardiac events (MACE) including all-cause mortality, heart transplantation, and implantable cardioverter defibrillator discharge. The predictors of MACE were examined with univariable and multivariable Cox regression analysis. Subsequently, nested Cox regression models were built to evaluate the incremental prognostic value of strain parameters. The incremental predictive power of strain parameters was assessed by Omnibus tests, and the model performance and discrimination were evaluated by Harrell C-index and integrated discrimination improvement (IDI) analysis. Patient survival was illustrated by Kaplan–Meier curves and differences were evaluated by log-rank test. During a median follow-up of 5.0 years, MACE were identified in 149 (36%) patients. LAεe, LVGLS, and RVGLS were the most predictive strain parameters for MACE (AUC: 0.854, 0.733, 0.733, respectively). Cox regression models showed that the predictive value of LAεe was independent from and incremental to LVGLS, RVGLS, and baseline variables (HR 0.74, 95% CI 0.68–0.81, P < 0.001). In reclassification analysis, the addition of LAεe provided the best discrimination of the model ( χ 2 223.34, P < 0.001; C-index 0.833; IDI 0.090, P < 0.001) compared with LVGLS and RVGLS models. Moreover, LAεe with a cutoff of 5.3% further discriminated the survival probability in subgroups of patients with positive LGE or reduced LVEF (all log-rank P < 0.001). LAεe provided the best prognostic value over biventricular strains and added incremental value to conventional clinical predictors for patients with DCM.
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Xiang et al. (2023) conducted a cohort in Dilated cardiomyopathy (n=412). Left atrial conduit strain (LAεe) vs. Baseline variables and biventricular strains was evaluated on Major adverse cardiac events (MACE) including all-cause mortality, heart transplantation, and implantable cardioverter defibrillator discharge (HR 0.74, 95% CI 0.68-0.81, p=<0.001). Every 1% increase in left atrial conduit strain (LAεe) was associated with a reduced risk of major adverse cardiac events (HR 0.74) in patients with dilated cardiomyopathy.
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