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. 2021 Apr;11(2):383-393.
doi: 10.21037/cdt-20-879.

Cardiac magnetic resonance derived left atrial strain after ST-elevation myocardial infarction: an independent prognostic indicator

Dhruv Nayyar  1   2 , Tuan Nguyen  1   3 , Faraz Pathan  4   5 , Giau Vo  1 , David Richards  6 , Liza Thomas  3   6   7 , Hany Dimitri  1   3 , James Otton  1   3
Affiliations

Cardiac magnetic resonance derived left atrial strain after ST-elevation myocardial infarction: an independent prognostic indicator

Dhruv Nayyar et al. Cardiovasc Diagn Ther. 2021 Apr.

Abstract

Background: The prognostic value of cardiac magnetic resonance (CMR) derived left atrial (LA) strain, ejection fraction (LAEF) and indexed volumes (LAVImax and LAVImin) after ST-elevation myocardial infarction (STEMI) remains controversial. The aim of this study was to assess the relationship between LA function and major adverse cardiovascular events (MACE) after STEMI.

Methods: A total of 202 prospectively recruited patients who underwent CMR at median day 4 after STEMI had complete CMR data for feature tracking assessment. LA reservoir and booster strain were quantified based on the average of three independently repeated measurements.

Results: MACE occurred in 35 patients during a median follow up of 607 days. Patients with MACE had lower median LA reservoir strain (18.9% vs. 29.4%, P<0.001), LA booster strain (9.4% vs. 13.0%, P=0.002) and LAEF (41.5% vs. 49.2%, P<0.001) than patients without MACE. Kaplan-Meier analyses demonstrated a difference in MACE between high- and low-risk groups for LA reservoir strain (cutoff 19.2%, P<0.001), LA booster strain (cutoff 9.7%, P<0.001) and LAEF (cutoff 38.5%, P<0.001). The AUC increased from 0.713 (95% CI: 0.608-0.818) for LVEF to 0.775 (95% CI: 0.680-0.870) when LA reservoir strain was added to LVEF (P=0.047). Univariate Cox regression analysis showed that all LA parameters had a significant effect on MACE, while multivariate analysis found LA reservoir strain was an independent predictor of MACE (HR 0.905; 95% CI: 0.843-0.972, P=0.006).

Conclusions: CMR derived LA reservoir strain independently predicted MACE after STEMI when adjusted for standard risk measures.

Keywords: Left atrial function; ST-elevation myocardial infarction (STEMI); cardiac magnetic resonance (CMR); left atrial strain; prognosis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/cdt-20-879). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
LA strain by CMR feature tracking. (A) Long axis four-chamber view, (B) long axis two-chamber view and (C) LA strain curve. The red line is the endocardial curve and the green line is the epicardial curve. ƐS, LA reservoir strain; Ɛa, LA booster strain. LA, Left atrial; CMR, cardiac magnetic resonance.
Figure 2
Figure 2
Study flowchart. CMR, cardiac magnetic resonance; STEMI, ST-elevation myocardial infarction.
Figure 3
Figure 3
Receiver operator characteristic curve evaluating LVEF compared to LA reservoir strain in addition to LVEF in predicting major adverse cardiovascular events. LVEF, left ventricular ejection fraction; LA, left atrial.
Figure 4
Figure 4
Kaplan Meier survival curves for (A) LA reservoir strain, (B) LA booster strain and (C) LAEF with major adverse cardiovascular events after dichotomisation, as calculated by the Youden index. LA, left atrial; LAEF, left atrial ejection fraction.
See this image and copyright information in PMC

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