Department of Medicine, University of Verona, Verona, Italy.
Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
JACC Cardiovasc Imaging. 2020 Jan;13(1 Pt 1):58-65. doi: 10.1016/j.jcmg.2019.03.002. Epub 2019 Mar 15.
OBJECTIVES: The purpose of this study was to determine the prognostic value of feature-tracking global longitudinal strain (GLS) measured during vasodilator stress cardiac magnetic resonance (CMR) imaging. BACKGROUND: Prior studies have suggested that blunted myocardial strain during dobutamine stress echocardiography may be associated with adverse prognosis. Recent developments in CMR feature-tracking techniques now allow assessment of strain in clinical practice using standard cine images without specialized pulse sequences or complex post-processing. Whether feature-tracking GLS measured during vasodilator stress provides independent and incremental prognostic data is unclear. METHODS: Consecutive patients undergoing stress perfusion CMR were prospectively enrolled (n = 535). Feature-tracking stress GLS was measured immediately after regadenoson perfusion. Patients were followed for major adverse cardiac events (MACE): death, nonfatal myocardial infarction, heart failure hospitalization, sustained ventricular tachycardia, and late revascularization. Cox proportional hazards regression modeling was used to examine the association between stress GLS and MACE. The incremental prognostic value of stress GLS was assessed in nested models. RESULTS: Over a median follow-up of 1.5 years, 82 patients experienced MACE. By Kaplan-Meier analysis, patients with stress GLS ≥ median (-19%) had significantly reduced event-free survival compared with those with stress GLS < median (log-rank p < 0.001). Stress GLS was significantly associated with risk of MACE after adjustment for clinical and imaging risk factors including ischemia, ejection fraction, and late gadolinium enhancement (hazard ratio: 1.267; p < 0.001). Addition of stress GLS into a model with clinical and imaging predictors resulted in significant increase in the C-index (from 0.80 to 0.85; p = 0.031) and a continuous net reclassification improvement of 0.898 (95% confidence interval: 0.565 to 1.124). CONCLUSIONS: Feature-tracking stress GLS measured during vasodilator stress CMR is an independent predictor of MACE in patients with known or suspected coronary artery disease, incremental to common clinical and imaging risk factors. These findings suggest a role for feature-tracking derived stress GLS in identifying patients at highest risk of adverse events following stress CMR.
目的：本研究旨在确定在血管扩张剂负荷心脏磁共振成像（CMR）期间测量的特征追踪整体纵向应变（GLS）的预后价值。
背景：先前的研究表明，多巴酚丁胺负荷超声心动图期间应变迟钝可能与不良预后相关。CMR 特征追踪技术的最新进展现在允许使用标准电影图像在临床实践中评估应变，而无需专门的脉冲序列或复杂的后处理。在血管扩张剂应激期间测量的特征追踪 GLS 是否提供独立且递增的预后数据尚不清楚。
方法：前瞻性纳入连续接受应激灌注 CMR 的患者（n=535）。在瑞加德松灌注后立即测量特征追踪应激 GLS。患者接受主要不良心脏事件（MACE）随访：死亡、非致死性心肌梗死、心力衰竭住院、持续性室性心动过速和晚期血运重建。使用 Cox 比例风险回归模型检查应激 GLS 与 MACE 之间的关联。在嵌套模型中评估应激 GLS 的增量预后价值。
结果：在中位数为 1.5 年的随访中，82 例患者发生 MACE。通过 Kaplan-Meier 分析，应激 GLS≥中位数（-19%）的患者与应激 GLS<中位数的患者相比，无事件生存明显降低（对数秩检验 p<0.001）。在调整包括缺血、射血分数和晚期钆增强在内的临床和影像学危险因素后，应激 GLS 与 MACE 风险显著相关（风险比：1.267；p<0.001）。将应激 GLS 添加到具有临床和影像学预测因子的模型中，导致 C 指数显著增加（从 0.80 增加到 0.85；p=0.031），连续净重新分类改善为 0.898（95%置信区间：0.565 至 1.124）。
结论：在已知或疑似冠状动脉疾病患者中，在血管扩张剂负荷 CMR 期间测量的特征追踪应激 GLS 是 MACE 的独立预测因子，比常见的临床和影像学危险因素更具增量价值。这些发现表明，特征追踪衍生的应激 GLS 在识别应激 CMR 后发生不良事件风险最高的患者方面具有作用。
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