AUTHOR=Lange Torben , Gertz Roman J. , Schulz Alexander , Backhaus Sören J. , Evertz Ruben , Kowallick Johannes T. , Hasenfuß Gerd , Desch Steffen , Thiele Holger , Stiermaier Thomas , Eitel Ingo , Schuster Andreas 

TITLE=Impact of myocardial deformation on risk prediction in patients following acute myocardial infarction

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1199936

DOI=10.3389/fcvm.2023.1199936

ISSN=2297-055X

ABSTRACT=Background: Cardiovascular magnetic resonance-feature tracking (CMR-FT) derived strain analyses provide incremental prognostic benefit in patients following acute myocardial infarction (AMI). This study aimed to evaluate and re-validate previously reported prognostic implications of comprehensive strain analyses in a large independent cohort of patients with ST-elevation myocardial infarction (STEMI).
Methods: Overall, 566 STEMI patients of the CONDITIONING-LIPSIA trial including pre-/postconditioning treatment and/or conventional percutaneous coronary intervention underwent CMR imaging in median 3 days after primary percutaneous coronary intervention. CMR-based left atrial (LA) reservoir (Es), conduit (Ee) and boosterpump (Ea) strain as well as left ventricular (LV) global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain analyses were carried out. Previously identified cut-off values were revalidated for risk stratification. Major adverse cardiac events (MACE) comprising death, reinfarction and new congestive heart failure were assessed within 12 months after the index event.
Results: Both atrial and ventricular strain values were significantly reduced in patients with MACE (p<0.01 for all). Predetermined LA and LV strain cut-offs enabled accurate risk assessment. All LA and LV strain values were associated with MACE on univariable regression modeling (p<0.001 for all) with LA Es emerging as independent predictor of MACE on multivariable regression modeling (HR 0.92, p=0.033). Furthermore, LA Es provided an incremental prognostic value above LVEF (c-index increase from 0.7 to 0.74, p=0.03).
Conclusion: External validation of CMR-FT-derived LA and LV strain evaluations confirmed the prognostic value of cardiac deformation assessment in STEMI patients. Within the current study especially LA strain parameters enabled further risk stratification and prognostic assessment over and above clinically established risk parameters.