Abstract
Purpose To investigate the prognostic value of circumferential left ventricular (LV) strain measured by using cardiac MRI for prediction of major adverse cardiac events (MACE) following an acute ST-segment-elevation myocardial infarction (STEMI). Materials and Methods Participants with acute STEMI were prospectively enrolled from May 11, 2011, to November 22, 2012. Cardiac MRI was performed at 1.5 T during the index hospitalization. Displacement encoding with stimulated echoes (DENSE) and feature tracking of cine cardiac MRI was used to assess circumferential LV strain. MACE that occurred after discharge were independently assessed by cardiologists blinded to the baseline observations. Results A total of 259 participants (mean age, 58 years ± 11 [standard deviation]; 198 men [mean age, 58 years ± 11] and 61 women [mean age, 58 years ± 12]) underwent cardiac MRI 2.2 days ± 1.9 after STEMI. Average infarct size was 18% ± 13 of LV mass and circumferential strain was -13% ± 3 (DENSE method) and -24% ± 7 (feature- tracking method). Fifty-one percent (131 of 259 participants) had presence of microvascular obstruction. During a median follow-up period of 4 years, 8% (21 of 259) experienced MACE. Area under the curve (AUC) for DENSE was different from that of feature tracking (AUC, 0.76 vs 0.62; P = .03). AUC for DENSE was similar to that of initial infarct size (P = .06) and extent of microvascular obstruction (P = .08). DENSE-derived strain provided incremental prognostic benefit over infarct size for prediction of MACE (hazard ratio, 1.3; P < .01). Conclusion Circumferential strain has independent prognostic importance in study participants with acute ST-segment-elevation myocardial infarction. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Kramer in this issue.
Highlights
Splacement encoding with stimulated echoes (DENSE) [18] encodes myocardial displacement directly into the phase of the cardiac MRI signal allowing for extraction of myocardial strain with pixel-level resolution, conferring a high level of accuracy and reproducibility compared with other methods [18]
Despite improved early survival after an acute ST-segment–elevation myocardial infarction (STEMI), the incidence of heart failure in the longer term has increased to 32% (1990–1999) from 10% only 20 years earlier [1,2]
Standard risk assessment for treatment stratification in individual patients is based on the left ventricular (LV) ejection fraction (LVEF) [3,4,5]
Summary
Splacement encoding with stimulated echoes (DENSE) [18] encodes myocardial displacement directly into the phase of the cardiac MRI signal allowing for extraction of myocardial strain with pixel-level resolution, conferring a high level of accuracy and reproducibility compared with other methods [18]. We hypothesized that DENSE-derived circumferential strain has superior prognostic value when compared with feature tracking of cine imaging
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