Feature Tracking Myocardial Strain Incrementally Improves Prognostication in Myocarditis Beyond Traditional CMR Imaging Features
Kady Fischer, Sarah J Obrist, Sophie A Erne, Anselm W Stark, Maximilian Marggraf, Kyoichi Kaneko, Dominik P Guensch, Adrian T Huber, Simon Greulich, Ayaz Aghayev, Michael Steigner, Ron Blankstein, Raymond Y Kwong, Christoph Gräni, Kady Fischer, Sarah J Obrist, Sophie A Erne, Anselm W Stark, Maximilian Marggraf, Kyoichi Kaneko, Dominik P Guensch, Adrian T Huber, Simon Greulich, Ayaz Aghayev, Michael Steigner, Ron Blankstein, Raymond Y Kwong, Christoph Gräni
Abstract
Objectives: This study investigated the association of cardiovascular cardiac magnetic resonance (CMR) feature tracking (FT) with outcome in a patient cohort with myocarditis and evaluated the possible incremental prognostic benefit beyond clinical features and traditional CMR features.
Background: CMR is used to diagnose and risk stratify patients with myocarditis. CMR-FT allows quantitative strain analysis of myocardial function; however, its prognostic benefit in myocarditis is unknown.
Methods: Consecutive patients with clinically suspected myocarditis and presence of midmyocardial or epicardial late gadolinium enhancement (LGE) and/or myocardial edema in CMR were included. Clinical and CMR features were analyzed with regard to major adverse cardiovascular events (MACE) (i.e., hospitalization for heart failure, sustained ventricular tachycardia, and all-cause mortality).
Results: Of 740 patients with clinically suspected myocarditis, 455 (61%) met our final diagnostic criteria based on CMR tissue characterization. At a median follow-up of 3.9 years, MACE occurred in 74 (16%) patients. In the univariable analysis, CMR-FT global longitudinal peak strain (GLS) was significantly associated with MACE. In a multivariable model adjusting for clinical variables (age, sex, body mass index, and acuteness of symptoms) and traditional CMR features (left ventricular ejection fraction [LVEF] and LGE extent), GLS remained independently associated with outcome (GLS hazard ratio: 1.21; 95% confidence interval: 1.08 to 1.36; p = 0.001) and incrementally improved prognostication (chi-square increases from 42.6 to 79.8 to 88.5; p < 0.001).
Conclusions: Myocardial strain using CMR-FT provides independent and incremental prognostic value over clinical features, LVEF, and LGE in patients with myocarditis. CMR-FT may serve as a novel marker to improve risk stratification in myocarditis. (CMR Features in Patients With Suspected Myocarditis [CMRMyo]; NCT03470571).
Keywords: cardiovascular magnetic resonance; feature tracking; late gadolinium enhancement; major adverse cardiac event; myocarditis; strain.
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed