TY - JOUR
T1 - Cardiac Magnetic Resonance Feature Tracking Global Longitudinal Strain and Prognosis After Heart Transplantation
AU - Shenoy, Chetan
AU - Romano, Simone
AU - Hughes, Andrew
AU - Okasha, Osama
AU - Nijjar, Prabhjot S.
AU - Velangi, Pratik
AU - Martin, Cindy M.
AU - Akçakaya, Mehmet
AU - Farzaneh-Far, Afshin
N1 - Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/9
Y1 - 2020/9
N2 - Objectives: This study determined the long-term prognostic significance of GLS assessed using CMR-FT in a large cohort of heart transplant recipients. Background: In heart transplant recipients, global longitudinal strain (GLS) assessed using echocardiography has shown promise in the prediction of clinical outcomes. We hypothesized that CMR feature tracking (CMR-FT) GLS is independently associated with long-term outcomes in heart transplant recipients. Methods: In a cohort of consecutive heart transplant recipients who underwent routine CMR for clinical surveillance, CMR-FT GLS was calculated from 3 long-axis cine CMR images. Associations between GLS and a composite endpoint of death or major adverse cardiac events (MACE), including retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization, were investigated. Results: A total of 152 heart transplant recipients (age 54 ± 15 years; 29% women; 5.0 ± 5.4 years after heart transplantation) were included. The median GLS was −11.6% (interquartile range: −13.6% to −9.2%). Over a median follow-up of 2.6 years, 59 recipients reached the composite endpoint. On Kaplan-Meier analyses, recipients with GLS worse than the median had a higher estimated cumulative incidence of the composite endpoint compared with recipients with GLS better than the median (log rank p = 0.004). On multivariate Cox proportional hazards regression, GLS was independently associated with the composite endpoint after adjustment for cardiac allograft vasculopathy, history of rejection, left ventricular ejection fraction (LVEF), right ventricular EF, and presence of myocardial fibrosis, with a hazard ratio of 1.15 for every 1% worsening in GLS (95% confidence interval: 1.06 to 1.24; p < 0.001). Similar results were seen in subgroups of recipients with LVEF >50% and with no myocardial fibrosis. GLS provided incremental prognostic value over other variables in the multivariate model as determined by the log-likelihood chi-squared test. Conclusions: In a large cohort of heart transplant recipients, CMR-FT GLS was independently associated with the long-term risk of death or MACE.
AB - Objectives: This study determined the long-term prognostic significance of GLS assessed using CMR-FT in a large cohort of heart transplant recipients. Background: In heart transplant recipients, global longitudinal strain (GLS) assessed using echocardiography has shown promise in the prediction of clinical outcomes. We hypothesized that CMR feature tracking (CMR-FT) GLS is independently associated with long-term outcomes in heart transplant recipients. Methods: In a cohort of consecutive heart transplant recipients who underwent routine CMR for clinical surveillance, CMR-FT GLS was calculated from 3 long-axis cine CMR images. Associations between GLS and a composite endpoint of death or major adverse cardiac events (MACE), including retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization, were investigated. Results: A total of 152 heart transplant recipients (age 54 ± 15 years; 29% women; 5.0 ± 5.4 years after heart transplantation) were included. The median GLS was −11.6% (interquartile range: −13.6% to −9.2%). Over a median follow-up of 2.6 years, 59 recipients reached the composite endpoint. On Kaplan-Meier analyses, recipients with GLS worse than the median had a higher estimated cumulative incidence of the composite endpoint compared with recipients with GLS better than the median (log rank p = 0.004). On multivariate Cox proportional hazards regression, GLS was independently associated with the composite endpoint after adjustment for cardiac allograft vasculopathy, history of rejection, left ventricular ejection fraction (LVEF), right ventricular EF, and presence of myocardial fibrosis, with a hazard ratio of 1.15 for every 1% worsening in GLS (95% confidence interval: 1.06 to 1.24; p < 0.001). Similar results were seen in subgroups of recipients with LVEF >50% and with no myocardial fibrosis. GLS provided incremental prognostic value over other variables in the multivariate model as determined by the log-likelihood chi-squared test. Conclusions: In a large cohort of heart transplant recipients, CMR-FT GLS was independently associated with the long-term risk of death or MACE.
KW - cardiac magnetic resonance
KW - heart transplantation
KW - prognosis
KW - strain
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U2 - 10.1016/j.jcmg.2020.04.004
DO - 10.1016/j.jcmg.2020.04.004
M3 - Article
C2 - 32563650
AN - SCOPUS:85089378929
SN - 1936-878X
VL - 13
SP - 1934
EP - 1942
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 9
ER -