Abstract
We aimed to evaluate the prognostic value of left ventricular global longitudinal strain (LVGLS) and left atrial strain (LAS) obtained from magnetic resonance imaging (MRI) feature tracking in patients with heart failure with preserved ejection fraction (HFpEF). We retrospectively enrolled consecutive patients with HFpEF admitted to our hospital who underwent cardiac MRI. LVGLS and LAS were obtained from cine MRI by feature tracking. The end point was defined as a composite of all-cause death, myocardial infarction, and hospitalization due to decompensated HF. One-hundred patients with HFpEF were enrolled. Mean LVGLS and LAS were − 13.7 ± 3.7% and 22.5 ± 11.6%, respectively. During follow-up of 4.4 ± 1.9 years, 24 events occurred. Multivariate Cox proportional hazards model analysis demonstrated LAS was independently associated with adverse cardiac events. Kaplan–Meier curve analysis revealed that the patients with both LVGLS and LAS worse than the median (LVGLS ≥ − 12.2% and LAS ≤ 13.8%) had a significantly lower event-free rate compared to those with preserved strain (Log-rank P < 0.001). Simultaneous assessment of LVGLS and LAS using MRI was useful for risk stratification in the patients with HFpEF.
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The data that support the findings of this study are available from the corresponding and institutional author [KF and YT], upon reasonable request.
References
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A (2022) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 24:4–131
Paulus WJ, Tschöpe C (2013) A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol 62:263–271
Fonarow Gregg C, Stough Wendy G, Abraham William T, Albert Nancy M, Gheorghiade M, Greenberg Barry H, O’Connor Christopher M, Sun Jie L, Yancy Clyde W, Young James B, Null N (2007) Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure. J Am College Cardiol 50:768–777
MacNamara JP, Sarma S (2021) Faltering under pressure: limitations to noninvasive diastolic function assessments. J Am Heart Assoc 10:e023189
Zile MR, Gottdiener JS, Hetzel SJ, McMurray JJ, Komajda M, McKelvie R, Baicu CF, Massie BM, Carson PE (2011) Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction. Circulation 124:2491–2501
Freed BH, Daruwalla V, Cheng JY, Aguilar FG, Beussink L, Choi A, Klein DA, Dixon D, Baldridge A, Rasmussen-Torvik LJ, Maganti K, Shah SJ (2016) Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction. Circ Cardiovasc Imaging 9:e003754
Bianco CM, Farjo PD, Ghaffar YA, Sengupta PP (2020) Myocardial mechanics in patients with normal LVEF and diastolic dysfunction. JACC Cardiovasc Imaging 13:258–271
Morais P, Marchi A, Bogaert JA, Dresselaers T, Heyde B, D’Hooge J, Bogaert J (2017) Cardiovascular magnetic resonance myocardial feature tracking using a non-rigid, elastic image registration algorithm: assessment of variability in a real-life clinical setting. J Cardiovasc Magn Reson 19:24
Endo K, Kiko T, Yamakuni R, Misaka T, Yamaki T, Nakazato K, Fukushima K, Takeishi Y (2022) Prognostic value of simultaneous analysis with myocardial flow reserve and right ventricular strain by hybrid <sup>13</sup>n-ammonia positron emission tomography/magnetic resonance imaging in coronary artery disease. Int Heart J 63:1063–1069
Fukushima K, Endo K, Yamakuni R, Kiko T, Sekino H, Kikori K, Ukon N, Ishii S, Yamaki T, Ito H, Takeishi Y (2023) Simultaneous assessment of left ventricular mechanical dyssynchrony using integrated (13)N-ammonia PETMR system: direct comparison of PET phase analysis and MR feature tracking. J Nucl Cardiol 30(5):1947–1958
Ring L, Rana BS, Wells FC, Kydd AC, Dutka DP (2014) Atrial function as a guide to timing of intervention in mitral valve prolapse with mitral regurgitation. JACC Cardiovasc Imaging 7:225–232
Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M, Marino E, Galderisi M (2009) Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound 7:6
Buss S, Andre F, Breuninger K, Lehrke S, Voss A, Galuschky C, Lossnitzer D, Ehlermann P, Franke J, Taeger T, Frankenstein L, Steen H, Meder B, Giannitsis E, Katus HA, Korosoglou G (2014) Prognostic value of myocardial strain analysis with cardiac magnetic resonance in patients with dilated cardiomyopathy. J Cardiovasc Magn Reson 16:O90
DeVore AD, McNulty S, Alenezi F, Ersboll M, Vader JM, Oh JK, Lin G, Redfield MM, Lewis G, Semigran MJ, Anstrom KJ, Hernandez AF, Velazquez EJ (2017) Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: insights from the RELAX trial. Eur J Heart Fail 19:893–900
Reddy YNV, Obokata M, Verbrugge FH, Lin G, Borlaug BA (2020) Atrial dysfunction in patients with heart failure with preserved ejection fraction and atrial fibrillation. J Am Coll Cardiol 76:1051–1064
Linseman JV, Bristow MR (2003) Drug therapy and heart failure prevention. Circulation 107:1234–1236
Faselis C, Arundel C, Patel S, Lam Phillip H, Gottlieb Stephen S, Zile Michael R, Deedwania P, Filippatos G, Sheriff Helen M, Zeng Q, Morgan Charity J, Wopperer S, Nguyen T, Allman Richard M, Fonarow Gregg C, Ahmed A (2020) Loop diuretic prescription and 30-day outcomes in older patients with heart failure. J Am Coll Cardiol 76:669–679
Meyer M, LeWinter MM (2019) Heart rate and heart failure with preserved ejection fraction. Circ Heart Fail 12:e006213
Erley J, Genovese D, Tapaskar N, Alvi N, Rashedi N, Besser SA, Kawaji K, Goyal N, Kelle S, Lang RM, Mor-Avi V, Patel AR (2019) Echocardiography and cardiovascular magnetic resonance based evaluation of myocardial strain and relationship with late gadolinium enhancement. J Cardiovasc Magn Reson 21:46
Becker MAJ, Cornel JH, van de Ven PM, van Rossum AC, Allaart CP, Germans T (2018) The prognostic value of late gadolinium-enhanced cardiac magnetic resonance imaging in nonischemic dilated cardiomyopathy: a review and meta-analysis. JACC Cardiovasc Imaging 11:1274–1284
Kato S, Saito N, Kirigaya H, Gyotoku D, Iinuma N, Kusakawa Y, Iguchi K, Nakachi T, Fukui K, Futaki M, Iwasawa T, Taguri M, Kimura K, Umemura S (2015) Prognostic significance of quantitative assessment of focal myocardial fibrosis in patients with heart failure with preserved ejection fraction. Int J Cardiol 191:314–319
Kanagala P, Cheng ASH, Singh A, Khan JN, Gulsin GS, Patel P, Gupta P, Arnold JR, Squire IB, Ng LL, McCann GP (2019) Relationship between focal and diffuse fibrosis assessed by CMR and clinical outcomes in heart failure with preserved ejection fraction. JACC Cardiovasc Imaging 12:2291–2301
Zhang Y, Mui D, Chirinos JA, Zamani P, Ferrari VA, Chen Y, Han Y (2021) Comparing cardiovascular magnetic resonance strain software packages by their abilities to discriminate outcomes in patients with heart failure with preserved ejection fraction. J Cardiovasc Magn Reson 23:55
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KF was supported by a research grant from JSPS KAKENHI (22K07701).
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Katahira, M., Fukushima, K., Kiko, T. et al. Prognostic significance of left atrial strain combined with left ventricular strain using cardiac magnetic resonance feature tracking in patients with heart failure with preserved ejection fraction. Heart Vessels 39, 404–411 (2024). https://doi.org/10.1007/s00380-023-02351-9
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DOI: https://doi.org/10.1007/s00380-023-02351-9