Prognostic value of myocardial deformation imaging by cardiac magnetic resonance feature-tracking in patients with a first ST-segment elevation myocardial infarction

Abstract

Aim: Scarce data are available whether cardiac magnetic resonance (CMR) assessment of myocardial deformation provides independent and incremental prognostic information in patients with ST-segment elevation myocardial infarction (STEMI). The aim of the present study was to investigate the prognostic utility of CMR feature-tracking derived left ventricular (LV) global circumferential strain (GCS) in STEMI patients.

Methods: A total of 180 patients (mean age 60 ± 12 years, 72% male) admitted because of a first STEMI were included. CMR with late gadolinium enhancement (LGE) imaging was performed to assess LV function, infarct size, and microvascular obstruction. The feature-tracking analysis was applied to cine-CMR short-axis images to assess LV GCS. Patients were followed-up for a median of 95 months. The outcome event was a composite endpoint including cardiovascular death, aborted sudden cardiac death, and hospitalization for heart failure.

Results: During follow-up, 40 (22%) patients experienced at least 1 event. After adjustment for other clinical and CMR imaging characteristics, LV GCS remained significantly and independently associated with the outcome event (HR 1.16 per %; 95% CI 1.07-1.25; p < 0.001). A significant increase of global χ² was observed when adding LV GCS to a model including clinical and non-contrast CMR variables (χ² change = 8.2; p = 0.004) and to a model including clinical, non-contrast and LGE variables (χ² change = 4.8; p = 0.028).

Conclusion: LV GCS assessed by CMR feature-tracking can predict a worse long-term prognosis in patients admitted with a first STEMI. More importantly, the predictive ability of LV GCS is incremental to other clinical and CMR variables.

Keywords: Cardiac magnetic resonance; Feature-tracking; Global circumferential strain; Prognosis; ST-elevation myocardial infarction.