Myocardial strain assessed by SENC or fast-SENC strongly predicted major adverse cardiovascular events (HR 4.1) and all-cause mortality (HR 3.0) in patients undergoing clinically indicated CMR.
Meta-Analysis (n=1,689)
Yes
Does myocardial strain assessment by HARP, SENC, or fast-SENC predict MACE and all-cause mortality in patients undergoing CMR?
Myocardial strain assessment by SENC/fast-SENC provides incremental prognostic value over clinical data and conventional CMR parameters for predicting MACE and all-cause mortality.
Effect estimate: HR 4.1 (95% CI 3.0-5.5)
p-value: p=<0.001
Cardiac magnetic resonance (CMR) is the gold standard for the diagnostic classification and risk stratification in most patients with cardiac disorders. The aim of the present study was to investigate the ability of Strain-encoded MR (SENC) for the prediction of major adverse cardiovascular events (MACE). A systematic review and meta-analysis was performed according to the PRISMA Guidelines, including patients with or without cardiovascular disease and asymptomatic individuals. Myocardial strain by HARP were used as pulse sequences in 1.5 T scanners. Published literature in MEDLINE (PubMed) and Cochrane's databases were explored before February 2023 for studies assessing the clinical utility of myocardial strain by Harmonic Phase Magnetic Resonance Imaging (HARP), Strain-encoded MR (SENC) or fast-SENC. In total, 8 clinical trials (4 studies conducted in asymptomatic individuals and 4 in patients with suspected or known cardiac disease) were included in this systematic review, while 3 studies were used for our meta-analysis, based on individual patient level data. Kaplan-Meier analysis and Cox proportional hazard models were used, testing the ability of myocardial strain by HARP and SENC/fast-SENC for the prediction of MACE. Strain enabled risk stratification in asymptomatic individuals, predicting MACE and the development of incident heart failure. Of 1332 patients who underwent clinically indicated CMR, including SENC or fast-SENC acquisitions, 19 patients died, 28 experienced non-fatal infarctions, 52 underwent coronary revascularization and 86 were hospitalized due to heart failure during median 22.4 (17.2-28.5) months of follow-up. SENC/fast-SENC, predicted both all-cause mortality and MACE with high accuracy (HR = 3.0, 95% CI = 1.2-7.6, p = 0.02 and HR = 4.1, 95% CI = 3.0-5.5, respectively, p < 0.001). Using hierarchical Cox-proportional hazard regression models, SENC/fast-SENC exhibited incremental value to clinical data and conventional CMR parameters. Reduced myocardial strain predicts of all-cause mortality and cardiac outcomes in symptomatic patients with a wide range of ischemic or non-ischemic cardiac diseases, whereas in asymptomatic individuals, reduced strain was a precursor of incident heart failure.
Korosoglou et al. (Thu,) conducted a meta-analysis in Suspected or known cardiac disease (n=1,689). Strain-encoded MR (SENC) or fast-SENC vs. Conventional CMR parameters (WMA, LGE, LVEF) and clinical data was evaluated on Major adverse cardiovascular events (MACE) (HR 4.1, 95% CI 3.0-5.5, p=<0.001). Myocardial strain assessed by SENC or fast-SENC strongly predicted major adverse cardiovascular events (HR 4.1) and all-cause mortality (HR 3.0) in patients undergoing clinically indicated CMR.