Myocardial Strain by Cardiac Magnetic Resonance: A Valuable Predictor of Outcome After Infarct Revascularization Publisher Pubmed



Rezaeikalantari K¹ ; Babaei R¹ ; Bakhshandeh H¹ ; Motevalli M¹ ; Bitarafanrajabi A^{2, 3} ; Kasani K¹ ; Jafari M⁴ ; Farahmand AM⁵ ; Sharifian M¹ Show Affiliations
Source: European Journal of Radiology Published:2021

Abstract

Purpose: To evaluate the prognostic value of left ventricular strains by cardiac magnetic resonance feature tracking (CMR-FT) in patients with re-perfused myocardial infarction (MI). Methods: The study enrolled 58 patients with re-vascularized MI who underwent CMR within a week from acute MI. An 18-month follow-up was carried out for the composite endpoint of major adverse cardiovascular events (MACE). A 3 to 6-month post-MI ejection fraction (EF) was also measured. The predictive value of global longitudinal, circumferential, and radial strains (GLS, GCS, and GRS, respectively) for MACE and the follow-up EF was evaluated. Results: All the global strains showed significant impairment in MACE positive cases (P < 0.05 for all). On univariate regression, MACE was reversely associated with early post-MI EF (OR: 0.90, 95% CI: 0.83–0.98, P: 0.01), and directly associated with GLS (OR: 1.32, 95% CI: 1.03–1.69, P: 0.02), GCS (OR: 1.23, 95% CI: 1.00–1.50, P: 0.04) and EDVI (OR:1.02, 95 %CI: 1.00–1.04, P: 0.01). On multivariate regression model, only the interaction between EF and GLS showed a significant association with MACE (OR[CI95%]: 1.1 [1.06–1.21]). EF < 30% and GLS > −8.9% had the highest sensitivity (78.9% and 89.5%, respectively) and specificity (45.2% and 54.8%, respectively) to predict MACE. The combination of EF < 30% and GLS > -8.9% increased the sensitivity to 94.7%. In addition, the cutoff values of 35.1% for early post-MI EF and −10% for GLS could identify patients with impaired follow-up EF with more than 80% sensitivity and specificity [AUC (CI95%): 0.893(0.76–1.00) for EF and AUC (CI95%):0.836(0.67–1,00) for GLS, P < 0.05 for both)]. Conclusions: GLS by CMR-FT is a powerful prognosticator of MACE and functional recovery in MI survivors, with incremental value added to early post-MI EF alone. © 2021