From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.).
Radiology. 2020 Aug;296(2):290-298. doi: 10.1148/radiol.2020200195. Epub 2020 Jun 2.
Background In heart failure with preserved ejection fraction (HFpEF), echocardiographic studies suggest that global longitudinal strain (GLS) has an impact on survival. Feature-tracking cardiovascular MRI also allows for strain analysis; however, to the knowledge of the authors, little is known about its prognostic value and whether it reflects severity of diffuse fibrosis, as assessed by cardiovascular MRI T1 mapping. Purpose To investigate the association between myocardial strain at cardiovascular MRI with extracellular volume by T1 mapping and outcome in participants with HFpEF. Materials and Methods In this secondary analysis of a prospective study (NCT03405987), consecutive participants with HFpEF underwent cardiovascular MRI between July 2012 and March 2018, including T1 mapping and three-dimensional strain analysis. Extracellular volume and strain results were assessed to determine if there was a correlation between these two factors. Cox regression was performed to determine the prognostic relevance of MRI-derived myocardial strain for a combined end point (events) of heart failure hospitalizations and cardiovascular death. Results In total, 206 consecutive participants with HFpEF (mean age, 71 years ± 8 [standard deviation]; 69% women) were included. Median myocardial global longitudinal strain (GLS) at MRI was -8.5% and showed low correlation with extracellular volume ( = 0.28; = .003). A total of 109 events (53%) were recorded during a follow-up of 38 months ± 29. Participants with a GLS above the median had higher event rates (log-rank test, < .001). By multivariable Cox regression analysis, GLS remained independently associated with outcome (hazard ratio, 1.06 per 1% strain increase; 95% confidence interval: 1.01, 1.11; = .03) when corrected for risk factors including age, diabetes, renal function, -terminal pro-b-type natriuretic peptide serum concentration, and right ventricular size and function. Conclusion In participants with heart failure with preserved ejection fraction, global longitudinal strain at cardiovascular MRI was correlated with extracellular volume by T1 mapping and was associated with cardiovascular events. © RSNA, 2020
背景 在射血分数保留的心力衰竭（HFpEF）中，超声心动图研究表明整体纵向应变（GLS）对生存率有影响。特征跟踪心血管 MRI 也允许进行应变分析；然而，据作者所知，对于其预后价值以及它是否反映心血管 MRI T1 映射评估的弥漫性纤维化的严重程度知之甚少。目的 研究心血管 MRI 心肌应变与 T1 映射评估的细胞外容积之间的相关性，并评估其与射血分数保留的心力衰竭患者结局的关系。材料与方法 在这项前瞻性研究（NCT03405987）的二次分析中，连续纳入 2012 年 7 月至 2018 年 3 月期间患有 HFpEF 的患者行心血管 MRI 检查，包括 T1 映射和三维应变分析。评估细胞外容积和应变结果，以确定这两个因素之间是否存在相关性。Cox 回归分析用于确定 MRI 衍生心肌应变对心力衰竭住院和心血管死亡综合终点（事件）的预后相关性。结果 共纳入 206 例连续的 HFpEF 患者（平均年龄，71 岁±8[标准差]；69%为女性）。MRI 检测的心肌整体纵向应变（GLS）中位数为-8.5%，与细胞外容积相关性较低（ = 0.28； =.003）。在 38 个月±29 的随访期间共记录到 109 例事件（53%）。GLS 中位数以上的患者事件发生率较高（对数秩检验， <.001）。多变量 Cox 回归分析显示，在校正年龄、糖尿病、肾功能、N 末端 pro-B 型利钠肽血清浓度和右心室大小和功能等危险因素后，GLS 仍然与结局独立相关（风险比，每增加 1%应变 1.06；95%置信区间：1.01，1.11； =.03）。结论 在射血分数保留的心力衰竭患者中，心血管 MRI 上的整体纵向应变与 T1 映射的细胞外容积相关，与心血管事件相关。 ©RSNA，2020
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