Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the same
Abstract Background Global longitudinal strain (GLS), most commonly measured at the endocardium, has been shown to be superior to left ventricular (LV) ejection fraction (LVEF) for the identification of systolic dysfunction and prediction of outcomes in heart failure (HF). We hypothesized that strai...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-12-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12968-020-00680-6 |
| _version_ | 1797203298011316224 |
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| author | Lingyu Xu Joseph J. Pagano Mark J. Haykowksy Justin A. Ezekowitz Gavin Y. Oudit Yoko Mikami Andrew Howarth James A. White Jason R. B. Dyck Todd Anderson D. Ian Paterson Richard B. Thompson for the AB HEART Investigators |
| author_facet | Lingyu Xu Joseph J. Pagano Mark J. Haykowksy Justin A. Ezekowitz Gavin Y. Oudit Yoko Mikami Andrew Howarth James A. White Jason R. B. Dyck Todd Anderson D. Ian Paterson Richard B. Thompson for the AB HEART Investigators |
| author_sort | Lingyu Xu |
| collection | DOAJ |
| description | Abstract Background Global longitudinal strain (GLS), most commonly measured at the endocardium, has been shown to be superior to left ventricular (LV) ejection fraction (LVEF) for the identification of systolic dysfunction and prediction of outcomes in heart failure (HF). We hypothesized that strains measured at different myocardial layers (endocardium = ENDO, epicardium = EPI, average = AVE) will have distinct diagnostic and predictive performance for patients with HF. Methods Layer-specific GLS, layer-specific global circumferential strain (GCS) and global radial strain (GRS) were evaluated by cardiovascular magnetic resonance imaging (CMR) feature tracking in the Alberta HEART study. A total of 453 subjects consisted of healthy controls (controls, n = 77), at-risk for HF (at-risk, n = 143), HF with preserved ejection fraction (HFpEF, n = 87), HF with mid-range ejection fraction (HFmrEF, n = 88) and HF with reduced ejection fraction (HFrEF, n = 58). For outcomes analysis, CMR-derived imaging parameters were adjusted with a base model that included age and N-terminal prohormone of b-type natriuretic peptide (NT-proBNP) to test their independent association with 5-year all-cause mortality. Results GLS_EPI distinguished all groups with preserved LVEF (controls − 16.5 ± 2.4% vs. at-risk − 15.5 ± 2.7% vs. HFpEF − 14.1 ± 3.0%, p < 0.001) while GLS_ENDO and all GCS (all layers) were similar among these groups. GRS was reduced in HFpEF (41.1 ± 13.8% versus 48.9 ± 10.7% in controls, p < 0.001) and the difference between GLS_EPI and GLS_ENDO were significantly larger in HFpEF as compared to controls. Within the preserved LVEF groups, reduced GRS and GLS_EPI were significantly associated with increased LV mass (LVM) and LVM/LV end-diastolic volume EDV (concentricity). In multivariable analysis, only GLS_AVE and GRS predicted 5-year all-cause mortality (all ps < 0.05), with the strongest association with 5-year all-cause mortality by Akaike Information Criterion analysis and significant incremental value for outcomes prediction beyond LVEF or GLS_ENDO by the likelihood ratio test. Conclusion Global strains measured on endocardium, epicardium or averaged across the wall thickness are not equivalent for the identification of systolic dysfunction or outcomes prediction in HF. The endocardium-specific strains were shown to have poorest all-around performance. GLS_AVE and GRS were the only CMR parameters to be significantly associated with 5-year all-cause mortality in multivariable analysis. GLS_EPI and GRS, as well as the difference in endocardial and epicardial strains, were sensitive to systolic dysfunction among HF patients with normal LVEF (> 55%), in whom lower strains were associated with increased concentricity. |
| first_indexed | 2024-04-24T08:17:06Z |
| format | Article |
| id | doaj.art-612b80b2bf574b15aa4b98f715a3d8d1 |
| institution | Directory Open Access Journal |
| issn | 1532-429X |
| language | English |
| last_indexed | 2024-04-24T08:17:06Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj.art-612b80b2bf574b15aa4b98f715a3d8d12024-04-17T03:16:57ZengElsevierJournal of Cardiovascular Magnetic Resonance1532-429X2020-12-0122111610.1186/s12968-020-00680-6Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the sameLingyu Xu0Joseph J. Pagano1Mark J. Haykowksy2Justin A. Ezekowitz3Gavin Y. Oudit4Yoko Mikami5Andrew Howarth6James A. White7Jason R. B. Dyck8Todd Anderson9D. Ian Paterson10Richard B. Thompson11for the AB HEART InvestigatorsDepartment of Biomedical Engineering, University of AlbertaDepartment of Biomedical Engineering, University of AlbertaCollege of Nursing and Health Innovation, The University of Texas ArlingtonDivision of Cardiology, University of AlbertaDivision of Cardiology, University of AlbertaStephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of AlbertaStephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of AlbertaStephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of AlbertaDepartment of Pediatrics, University of AlbertaCumming School of Medicine, University of CalgaryDivision of Cardiology, University of AlbertaDepartment of Biomedical Engineering, University of AlbertaAbstract Background Global longitudinal strain (GLS), most commonly measured at the endocardium, has been shown to be superior to left ventricular (LV) ejection fraction (LVEF) for the identification of systolic dysfunction and prediction of outcomes in heart failure (HF). We hypothesized that strains measured at different myocardial layers (endocardium = ENDO, epicardium = EPI, average = AVE) will have distinct diagnostic and predictive performance for patients with HF. Methods Layer-specific GLS, layer-specific global circumferential strain (GCS) and global radial strain (GRS) were evaluated by cardiovascular magnetic resonance imaging (CMR) feature tracking in the Alberta HEART study. A total of 453 subjects consisted of healthy controls (controls, n = 77), at-risk for HF (at-risk, n = 143), HF with preserved ejection fraction (HFpEF, n = 87), HF with mid-range ejection fraction (HFmrEF, n = 88) and HF with reduced ejection fraction (HFrEF, n = 58). For outcomes analysis, CMR-derived imaging parameters were adjusted with a base model that included age and N-terminal prohormone of b-type natriuretic peptide (NT-proBNP) to test their independent association with 5-year all-cause mortality. Results GLS_EPI distinguished all groups with preserved LVEF (controls − 16.5 ± 2.4% vs. at-risk − 15.5 ± 2.7% vs. HFpEF − 14.1 ± 3.0%, p < 0.001) while GLS_ENDO and all GCS (all layers) were similar among these groups. GRS was reduced in HFpEF (41.1 ± 13.8% versus 48.9 ± 10.7% in controls, p < 0.001) and the difference between GLS_EPI and GLS_ENDO were significantly larger in HFpEF as compared to controls. Within the preserved LVEF groups, reduced GRS and GLS_EPI were significantly associated with increased LV mass (LVM) and LVM/LV end-diastolic volume EDV (concentricity). In multivariable analysis, only GLS_AVE and GRS predicted 5-year all-cause mortality (all ps < 0.05), with the strongest association with 5-year all-cause mortality by Akaike Information Criterion analysis and significant incremental value for outcomes prediction beyond LVEF or GLS_ENDO by the likelihood ratio test. Conclusion Global strains measured on endocardium, epicardium or averaged across the wall thickness are not equivalent for the identification of systolic dysfunction or outcomes prediction in HF. The endocardium-specific strains were shown to have poorest all-around performance. GLS_AVE and GRS were the only CMR parameters to be significantly associated with 5-year all-cause mortality in multivariable analysis. GLS_EPI and GRS, as well as the difference in endocardial and epicardial strains, were sensitive to systolic dysfunction among HF patients with normal LVEF (> 55%), in whom lower strains were associated with increased concentricity.https://doi.org/10.1186/s12968-020-00680-6Layer-specific global longitudinal strainCardiovascular magnetic resonance imagingFeature trackingHeart failurePrognosis |
| spellingShingle | Lingyu Xu Joseph J. Pagano Mark J. Haykowksy Justin A. Ezekowitz Gavin Y. Oudit Yoko Mikami Andrew Howarth James A. White Jason R. B. Dyck Todd Anderson D. Ian Paterson Richard B. Thompson for the AB HEART Investigators Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the same Journal of Cardiovascular Magnetic Resonance Layer-specific global longitudinal strain Cardiovascular magnetic resonance imaging Feature tracking Heart failure Prognosis |
| title | Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the same |
| title_full | Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the same |
| title_fullStr | Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the same |
| title_full_unstemmed | Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the same |
| title_short | Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the same |
| title_sort | layer specific strain in patients with heart failure using cardiovascular magnetic resonance not all layers are the same |
| topic | Layer-specific global longitudinal strain Cardiovascular magnetic resonance imaging Feature tracking Heart failure Prognosis |
| url | https://doi.org/10.1186/s12968-020-00680-6 |
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