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JACC Cardiovasc Imaging. 2018 Oct;11(10):1419-1429. doi: 10.1016/j.jcmg.2017.10.024. Epub 2018 Jan 17.

Feature-Tracking Global Longitudinal Strain Predicts Death in a Multicenter Population of Patients With Ischemic and Nonischemic Dilated Cardiomyopathy Incremental to Ejection Fraction and Late Gadolinium Enhancement.

Author information

1
Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Department of Medicine, University of Verona, Verona, Italy.
2
Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina.
3
Department of Cardiology, New York Methodist Hospital, New York, New York.
4
Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
5
Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
6
Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois. Electronic address: afshin@uic.edu.

Abstract

OBJECTIVES:

The aim of this study was to evaluate the prognostic value of cardiac magnetic resonance (CMR) feature-tracking-derived global longitudinal strain (GLS) in a large multicenter population of patients with ischemic and nonischemic dilated cardiomyopathy.

BACKGROUND:

Direct assessment of myocardial fiber deformation with GLS using echocardiography or CMR feature tracking has shown promise in providing prognostic information incremental to ejection fraction (EF) in single-center studies. Given the growing use of CMR for assessing persons with left ventricular (LV) dysfunction, we hypothesized that feature-tracking-derived GLS may provide independent prognostic information in a multicenter population of patients with ischemic and nonischemic dilated cardiomyopathy.

METHODS:

Consecutive patients at 4 U.S. medical centers undergoing CMR with EF <50% and ischemic or nonischemic dilated cardiomyopathy were included in this study. Feature-tracking GLS was calculated from 3 long-axis cine-views. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the association between GLS and death. Incremental prognostic value of GLS was assessed in nested models.

RESULTS:

Of the 1,012 patients in this study, 133 died during median follow-up of 4.4 years. By Kaplan-Meier analysis, the risk of death increased significantly with worsening GLS tertiles (log-rank p < 0.0001). Each 1% worsening in GLS was associated with an 89.1% increased risk of death after adjustment for clinical and imaging risk factors including EF and late gadolinium enhancement (LGE) (hazard ratio [HR]:1.891 per %; p < 0.001). Addition of GLS in this model resulted in significant improvement in the C-statistic (0.628 to 0.867; p < 0.0001). Continuous net reclassification improvement (NRI) was 1.148 (95% confidence interval: 0.996 to 1.318). GLS was independently associated with death after adjustment for clinical and imaging risk factors (including EF and late gadolinium enhancement) in both ischemic (HR: 1.942 per %; p < 0.001) and nonischemic dilated cardiomyopathy subgroups (HR: 2.101 per %; p < 0.001).

CONCLUSIONS:

CMR feature-tracking-derived GLS is a powerful independent predictor of mortality in a multicenter population of patients with ischemic or nonischemic dilated cardiomyopathy, incremental to common clinical and CMR risk factors including EF and LGE.

KEYWORDS:

cardiac magnetic resonance imaging; cardiomyopathy; feature tracking; global longitudinal strain; left ventricular function; mortality; prognosis

PMID:
29361479
PMCID:
PMC6043421
DOI:
10.1016/j.jcmg.2017.10.024
[Indexed for MEDLINE]
Free PMC Article

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