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- Title
Prognostic implications of cardiac magnetic resonance feature tracking derived multidirectional strain in patients with chronic aortic regurgitation.
- Authors
Fernández-Golfín, Covadonga; Hinojar-Baydes, Rocío; González-Gómez, Ariana; Monteagudo, Juan Manuel; Esteban, Amparo; Alonso-Salinas, Gonzalo; Fernández, Maria Angeles; García-Martín, Ana; Santoro, Ciro; Pascual-Izco, Marina; Jiménez-Nacher, Jose Julio; Zamorano, Jose Luis
- Abstract
<bold>Objective: </bold>Speckle-tracking echocardiography (STE) deformation parameters detect latent LV dysfunction in chronic aortic regurgitation (AR) and are associated with outcomes. The aim of the study was to evaluate cardiac magnetic resonance (CMR) feature tracking (FT) deformation parameters in asymptomatic patients with AR and implications in outcomes.<bold>Methods: </bold>Fifty-five patients with AR and 54 controls were included. Conventional functional CMR parameters, aortic regurgitant volume, and fraction were assessed. CMR-FT analysis was performed with a dedicated software. Clinical data was obtained from hospital records. A combined endpoint included all-cause mortality, cardiovascular mortality, aortic valve surgery, or cardiovascular hospital admission due to heart failure.<bold>Results: </bold>Left ventricular (LV) mechanics is impaired in patients with significant AR. Significant differences were noted in global longitudinal strain (GLS) between controls and AR patients (- 19.1 ± 2.9% vs - 16.5 ± 3.2%, p < 0.001) and among AR severity groups (- 18.3 ± 3.1% vs - 16.2 ± 1.6% vs - 15 ± 3.5%; p = 0.02 for AR grades I-II, III, and IV). In univariate and multivariate analyses, circumferential strain (GCS) and global radial strain (GRS) but not GLS were associated with and increased risk of the end point with a HR of 1.26 (p = 0.016, 1.04-1.52) per 1% worsening for GCS and 0.90 (p = 0.012, 0.83-0.98) per 1% worsening for GRS.<bold>Conclusions: </bold>CMR-FT myocardial deformation parameters are impaired in patients with AR not meeting surgical criteria. GLS decreases early in the course of the disease and is a marker of AR severity while GCS and GRS worsen later but predict a bad prognosis, mainly the need of aortic valve surgery.<bold>Key Points: </bold>• CMR feature tracking LV mechanic parameters may be reduced in significant chronic AR with normal EF. • LV mechanics, mainly global longitudinal strain, worsens as AR severity increases. • LV mechanics, specially global radial and circumferential strain, is associated with a worse prognosis in AR patients.
- Subjects
CARDIAC magnetic resonance imaging; AORTIC valve insufficiency; AORTIC valve surgery; HEART failure; GLASGOW Coma Scale; LEFT ventricular dysfunction; LEFT heart ventricle; ECHOCARDIOGRAPHY; PREDICTIVE tests; NUCLEAR magnetic resonance spectroscopy; PROGNOSIS; MAGNETIC resonance imaging; HEART physiology
- Publication
European Radiology, 2021, Vol 31, Issue 7, p5106
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-020-07651-6