Abstract
Background: Cardiovascular magnetic resonance-feature tracking (CMR-FT) derived strain analyses provide incremental prognosticbenefit in patients following acute myocardial infarction (AMI). This study aimed to evaluate and re-validate previously reportedprognostic implications of comprehensive strain analyses in a large independent cohort of patients with ST-elevation myocardialinfarction (STEMI). Methods: Overall, 566 STEMI patients of the CONDITIONING-LIPSIA trial including pre-/postconditioning treatment and/orconventional percutaneous coronary intervention underwent CMR imaging in median 3 days after primary percutaneous coronaryintervention. CMR-based left atrial (LA) reservoir (Es), conduit (Ee) and boosterpump (Ea) strain as well as left ventricular (LV)global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain analyses were carried out. Previously identified cut-offvalues were revalidated for risk stratification. Major adverse cardiac events (MACE) comprising death, reinfarction and newcongestive heart failure were assessed within 12 months after the index event. Results: Both atrial and ventricular strain values were significantly reduced in patients with MACE (p<0.01 for all). PredeterminedLA and LV strain cut-offs enabled accurate risk assessment. All LA and LV strain values were associated with MACE on univariableregression modeling (p<0.001 for all) with LA Es emerging as independent predictor of MACE on multivariable regression modeling(HR 0.92, p=0.033). Furthermore, LA Es provided an incremental prognostic value above LVEF (c-index increase from 0.7 to 0.74,p=0.03). Conclusion: External validation of CMR-FT-derived LA and LV strain evaluations confirmed the prognostic value of cardiacdeformation assessment in STEMI patients. Within the current study especially LA strain parameters enabled further riskstratification and prognostic assessment over and above clinically established risk parameters.
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