Key result
LGE predicts ~245% higher MACE risk in patients with LVNC and reduced ejection fraction.
Why the study?
The prognostic value of CMR parameters, particularly feature tracking, was not well known in patients with LVNC and left ventricular dysfunction.
Do CMR feature tracking parameters improve prognostic value over traditional CMR parameters like LGE in patients with left ventricular noncompaction and reduced LVEF?
Cohort (n=55)
Yes
Do CMR feature tracking parameters improve prognostic value over traditional CMR parameters like LGE in patients with left ventricular noncompaction and reduced LVEF?
Hazard Ratio: 3.452 (95% CI 1.133–10.518)
p-value: p=0.029
In patients with LVNC and reduced LVEF, the presence of LGE on CMR is a strong independent predictor of adverse cardiovascular events, whereas CMR feature tracking for myocardial strain does not add incremental prognostic value.
LGE independently predicts MACE in LVNC with reduced LVEF; leaves open whether CMR-FT adds incremental prognostic value.
BACKGROUND: Cardiac magnetic resonance (CMR) has been used to diagnose and risk-stratify patients with left ventricular noncompaction (LVNC). The prognostic value of CMR parameters for LVNC, especially feature tracking (CMR-FT), is not well known in LVNC patients with left ventricular dysfunction. The present study aimed to investigate whether the combination of CMR-FT with traditional CMR parameters can increase the prognostic value of CMR for LVNC patients with reduced left ventricular ejection fraction (LVEF). METHODS: A total of 123 candidates were retrospectively included in this multicenter study and 55 LVNC patients (mean age, 45.7 ± 16.2 years; 61.8% men) remained after applying the exclusion criteria. Clinical features, left ventricular (LV) function parameters, global and segment myocardial strain, and late gadolinium enhancement (LGE) were evaluated. The outcomes include the composite events of cardiovascular death, heart transplantation, hospitalization for heart failure, thromboembolic events, and ventricular arrhythmias. RESULTS: After a median follow-up of 5.17 years (interquartile range: 0.17 to 10.58 years), 24 (36.8%) patients experienced at least one major adverse cardiovascular event (MACE). The myocardial strain parameters of patients with events were lower than those of patients without events. In the univariable Cox analysis, LVEF, the presence of LGE, global longitudinal strain (GLS) and segmental strains, including longitudinal strain at the apical level and radial and circumferential strain at the basal level, were significantly associated with MACEs. In the multivariate analysis, LGE (hazard ratio (HR) 3.452, 95% CI 1.133 to 10.518, p = 0.029) was a strong predictor of MACEs and significantly improved the predictive value (chi-square of the model after adding LGE: 7.51 vs. 13.47, p = 0.009). However, myocardial strain parameters were not statistically significant for the prediction of MACEs after adjusting for age, body mass index, LVEF and the presence of LGE and did not increase the prognostic value (chi-square of the model after adding GLS: 13.47 vs. 14.14, p = 0.411) in the multivariate model. CONCLUSIONS: The combination of CMR-FT with traditional CMR parameters may not increase the prognostic value of CMR in LVNC patients with reduced LVEF, while the presence of LGE was a strong independent predictor of MACEs and significantly improved the predictive value.
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Xu et al. (2022) conducted a cohort in Left ventricular noncompaction (LVNC) with left ventricular dysfunction (n=55). Late gadolinium enhancement (LGE) vs. Absence of LGE was evaluated on Major adverse cardiovascular events (MACEs), including cardiovascular death, heart transplantation, hospitalization for heart failure, thromboembolic events, and ventricular arrhythmias (HR 3.452, 95% CI 1.133-10.518, p=0.029). The presence of late gadolinium enhancement was a strong independent predictor of major adverse cardiovascular events (HR 3.452) in patients with left ventricular noncompaction and reduced ejection fraction.
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