Sun Wei, Yuan Yating, Shen Xuehua, Zhang Yiwei, Dong Nianguo, Wang Guohua, Li Yuman, Liang Bo, Lv Qing, Zhang Li, Xie Mingxing
Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, 430022, China.
Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, 430022, China.
Eur Radiol. 2023 Jun;33(6):3878-3888. doi: 10.1007/s00330-022-09327-9. Epub 2022 Dec 20.
The prognostic value of cardiac magnetic resonance feature tracking (CMR-FT)-derived right ventricular longitudinal strain (RVLS) post-heart transplantation has not been studied. This study aimed to evaluate the prognostic significance of CMR-FT-derived RVLS, in patients post- heart transplantation and to directly compare its value with that of conventional RV ejection fraction (RVEF).
In a cohort of consecutive heart transplantation recipients who underwent CMR for surveillance, RVLS from the free wall was measured by CMR-FT. The composite endpoint was all-cause death or major adverse cardiac events. The Cox regression model was used to examine the independent association between RVLS and the endpoint.
A total of 96 heart transplantation recipients were retrospectively included. Over a median follow-up of 41 months, 20 recipients reached the composite endpoint. The multivariate Cox analysis showed that the model with RVLS (hazard ratio [HR]:1.334; 95% confidence interval [CI]:1.148 to 1.549; p < 0.001; Akaike information criterion [AIC] = 140, C-index = 0.831) was better in predicting adverse events than the model with RVEF (HR:0.928; 95% CI: 0.868 to 0.993; p = 0.030; AIC = 149, C-index = 0.751). Furthermore, receiver operating characteristic curves revealed that the accuracy for predicting adverse events was greater for RVLS than RVEF (area under the curve: 0.85 vs 0.76, p = 0.03).
CMR-FT-derived RVLS is an independent predictor of adverse events in post-heart transplantation, and its predictive value was better than RVEF. Therefore, our study highlighted the importance of evaluating RVLS for risk stratification after heart transplantation.
• CMR-RVLS is an independent predictor of adverse events post-heart transplantation and provides greater predictive value. • CMR-RVLS may help clinicians to risk stratification in heart transplantation recipients.
心脏磁共振特征追踪（CMR-FT）衍生的右心室纵向应变（RVLS）在心脏移植后的预后价值尚未得到研究。本研究旨在评估CMR-FT衍生的RVLS在心脏移植患者中的预后意义，并将其价值与传统的右心室射血分数（RVEF）直接进行比较。
在一组接受CMR监测的连续心脏移植受者中，通过CMR-FT测量游离壁的RVLS。复合终点为全因死亡或主要不良心脏事件。采用Cox回归模型检验RVLS与终点之间的独立关联。
共回顾性纳入96例心脏移植受者。在中位随访41个月期间，20例受者达到复合终点。多变量Cox分析显示，包含RVLS的模型（风险比[HR]：1.334；95%置信区间[CI]：1.148至1.549；p<0.001；赤池信息准则[AIC]=140，C指数=0.831）在预测不良事件方面优于包含RVEF的模型（HR：0.928；95%CI：0.868至0.993；p=0.030；AIC=149，C指数=0.751）。此外，受试者工作特征曲线显示，RVLS预测不良事件的准确性高于RVEF（曲线下面积：0.85对0.76，p=0.03）。
CMR-FT衍生的RVLS是心脏移植后不良事件的独立预测因子，其预测价值优于RVEF。因此，我们的研究强调了评估RVLS对心脏移植后风险分层的重要性。
•CMR-RVLS是心脏移植后不良事件的独立预测因子，具有更高的预测价值。•CMR-RVLS可能有助于临床医生对心脏移植受者进行风险分层。
