William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.
William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.
J Am Coll Cardiol. 2024 Aug 13;84(7):648-659. doi: 10.1016/j.jacc.2024.05.050.
Myocardial strain using cardiac magnetic resonance (CMR) is a sensitive marker for predicting adverse outcomes in many cardiac disease states, but the prognostic value in the general population has not been studied conclusively.
The goal of this study was to assess the independent prognostic value of CMR feature tracking (FT)-derived LV global longitudinal (GLS), circumferential (GCS), and radial strain (GRS) metrics in predicting adverse outcomes (heart failure, myocardial infarction, stroke, and death).
Participants from the UK Biobank population imaging study were included. Univariable and multivariable Cox models were used for each outcome and each strain marker (GLS, GCS, GRS) separately. The multivariable models were tested with adjustment for prognostically important clinical features and conventional global LV imaging markers relevant for each outcome.
Overall, 45,700 participants were included in the study (average age 65 ± 8 years), with a median follow-up period of 3 years. All univariable and multivariable models demonstrated that lower absolute GLS, GCS, and GRS were associated with increased incidence of heart failure, myocardial infarction, stroke, and death. All strain markers were independent predictors (incrementally above some respective conventional LV imaging markers) for the morbidity outcomes, but only GLS predicted death independently: (HR: 1.18; 95% CI: 1.07-1.30).
In the general population, LV strain metrics derived using CMR-FT in radial, circumferential, and longitudinal directions are strongly and independently predictive of heart failure, myocardial infarction, and stroke, but only GLS is independently predictive of death in an adult population cohort.
心脏磁共振（CMR）心肌应变是预测多种心脏疾病不良结局的敏感标志物，但在普通人群中的预后价值尚未得到明确研究。
本研究旨在评估 CMR 斑点追踪（FT）衍生的左心室整体纵向应变（GLS）、环向应变（GCS）和径向应变（GRS）指标在预测不良结局（心力衰竭、心肌梗死、卒中和死亡）方面的独立预后价值。
纳入 UK Biobank 人群影像学研究的参与者。采用单变量和多变量 Cox 模型分别对每个结局和每个应变标志物（GLS、GCS、GRS）进行分析。对多变量模型进行了检验，调整了对预后有重要影响的临床特征和与每个结局相关的传统整体 LV 影像学标志物。
共有 45700 名参与者纳入本研究（平均年龄 65±8 岁），中位随访时间为 3 年。所有单变量和多变量模型均表明，GLS、GCS 和 GRS 的绝对值越低，心力衰竭、心肌梗死、卒中和死亡的发生率越高。所有应变标志物都是发病率结局的独立预测因素（在各自的一些传统 LV 影像学标志物之上有所增加），但只有 GLS 可以独立预测死亡：（HR：1.18；95%CI：1.07-1.30）。
在普通人群中，CMR-FT 衍生的左心室应变指标在径向、环向和纵向方向上均强烈且独立地预测心力衰竭、心肌梗死和卒中等不良结局，但只有 GLS 可独立预测成人人群的死亡。
