Extracellular Volume and Global Longitudinal Strain Both Associate With Outcomes But Correlate Minimally

JACC-CARDIOVASCULAR IMAGING

卷:13

Article

Frojdh, Fredrika^1,2  Fridman, Yaron³  Bering, Patrick⁴  Sayeed, Aatif⁴  Maanja, Maren^1,2  Niklasson, Louise^1,2  Olausson, Eric^1,2  Pi, Hongyang⁴  Azeem, Ali⁴  Wong, Timothy C.^4,5,6,7  Kellman, Peter⁸  Feingold, Brian^7,9  Christopher, Adam⁹  Fukui, Miho¹⁰  Cavalcante, Joao L.¹⁰  Miller, Christopher A.^11,12,13  Butler, Javed¹⁴  Ugander, Martin^1,2,15,16  Schelbert, Erik B.^4,5,6,7 

[1] Karolinska Univ Hosp, Dept Clin Physiol, Stockholm, Sweden

[2] Karolinska Inst, Stockholm, Sweden

[3] Mission Hosp, Asheville Cardiol Associates, Asheville, NC USA

[4] UPMC, UPMC Cardiovasc Magnet Resonance Ctr, Pittsburgh, PA USA

[5] Univ Pittsburgh, Sch Med, Dept Med, Pittsburgh, PA 15101 USA

[6] UPMC, Heart & Vasc Inst, Pittsburgh, PA USA

[7] Univ Pittsburgh, Clin & Translat Sci Inst, Pittsburgh, PA 15101 USA

[8] NHLBI, Bldg 10, Bethesda, MD 20892 USA

[9] Univ Pittsburgh, Sch Med, Dept Pediat, Pittsburgh, PA 15261 USA

[10] Abbott NW Hosp, Minneapolis Heart Inst, Minneapolis, MN USA

[11] Univ Manchester, Div Cardiovasc Sci, Sch Med Sci, Fac Biol Med & Hlth,Manchester Acad Hlth Sci Ctr, Manchester, Lancs, England

[12] Manchester Univ NHS Fdn Trust, Manchester, Lancs, England

[13] Univ Manchester, Wellcome Ctr Cell Matrix Res, Div Cell Matrix Biol & Regenerat Med, Sch Biol,Fac Biol Med & Hlth,Manchester Acad Hlth, Manchester, Lancs, England

[14] Univ Mississippi, Dept Med, Jackson, MS USA

[15] Univ Sydney, Kolling Inst, Royal North Shore Hosp, Sydney, NSW, Australia

[16] Univ Sydney, Sydney Med Sch, Northern Clin Sch, Sydney, NSW, Australia

关键词: cardiac magnetic resonance;    extracellular volume;    global longitudinal strain;    interstitium;    myocardial fibrosis;   

DOI  :  10.1016/j.jcmg.2020.04.026

来源: Elsevier

【 摘 要 】

OBJECTIVES This study examined how extracellular volume (ECV) and global longitudinal strain (GLS) relate to each other and to outcomes. BACKGROUND Among myriad changes occurring in diseased myocardium, left ventricular imaging metrics of either the interstitium (e.g., ECV) or contractile function (e.g., GLS) may consistently associate with adverse outcomes yet correlate minimally with each other. This scenario suggests that ECV and GLS potentially represent distinct domains of cardiac vulnerability. METHODS The study included 1,578 patients referred for cardiovascular magnetic resonance (CMR) without amyloidosis, and it quantified how ECV associated with GLS in linear regression models. ECV and GLS were then compared in their associations with incident outcomes (death and hospitalization for heart failure). RESULTS ECV and GLS correlated minimally (R-2 = 0.04). Over a median follow-up of 5.6 years, 339 patients experienced adverse events (149 hospitalizations for heart failure, 253 deaths, and 63 with both). GLS (univariable hazard ratio: 2.07 per 5% increment; 95% CI: 1.86 to 2.29) and ECV (univariable hazard ratio: 1.66 per 4% increment; 95% CI: 1.51 to 1.82) were principal variables associating with outcomes in univariable and multivariable Cox regression models. Similar results were observed in several clinically important subgroups. In the whole cohort, ECV added prognostic value beyond GLS in univariable and multivariable Cox regression models. CONCLUSIONS GLS and ECV may represent principal but distinct domains of cardiac vulnerability, perhaps reflecting their distinct cellular origins. Whether combining ECV and GLS may advance pathophysiological understanding for a given patient, optimize risk stratification, and foster personalized medicine by targeted therapeutics requires further investigation. (C) 2020 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.

【 授权许可】

Free