Background

The assessment of myocardial fiber deformation with cardiac magnetic resonance feature tracking (CMR-FT) has shown to be promising in terms of prognostic information in several structural heart diseases. However, little is known about its role in hypertrophic cardiomyopathy (HCM). Aims of the present study were: 1) to assess the prognostic role of CMR-FT derived strain parameters in patients with HCM.

Methods

CMR was performed in 130 consecutive HCM patients (93 males, mean age (54 ± 17 years) with an estimated 5-year risk of sudden cardiac death (SCD) <6% according to the HCM Risk-SCD calculator. 2D- and 3D-Global Radial (GRS), Longitudinal (GLS) and Circumferential (GCS) Strain was evaluated by FT analysis. The primary outcome of the study was a composite of major adverse cardiac events (MACE) including SCD, resuscitated cardiac arrest due to ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia (VT), and hospitalization for heart failure.

Results

After a median follow-up of 51.7 (37.1–68.8) months, 4 (3%) patients died (all of them suffered from SCD) and 36 (28%) were hospitalized for heart failure. After multivariable adjustment for clinical and imaging covariates, among all strain parameters, only GLS remained a significant independent predictor of outcome events in both the model including 2D strain (HR 1.12, 95% CI 1.03–1.23, p = 0.01) and the model including 3D strain (HR 1.14, 95% CI 1.01–1.30, p = 0.04). The addition of 2D-GLS into the model with clinical and imaging predictors resulted in a significant increase in the C-statistic (from 0.48 to 0.65, p = 0.03).

Conclusion

CMR-FT derived GLS is a powerful independent predictor of MACE in patients with HCM, incremental to common clinical and CMR risk factors including left ventricular ejection fraction and late gadolinium enhancement.

中文翻译：

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通过特征跟踪对肥厚型心肌病患者整体纵向应变的预后作用：STRAIN-HCM 研究

背景

使用心脏磁共振特征跟踪 (CMR-FT) 评估心肌纤维变形在几种结构性心脏病的预后信息方面显示出前景。然而，对其在肥厚型心肌病 (HCM) 中的作用知之甚少。本研究的目的是：1) 评估 CMR-FT 衍生的应变参数在 HCM 患者中的预后作用。

方法

根据 HCM 风险-SCD 计算器，对 130 名连续 HCM 患者（93 名男性，平均年龄 (54 ± 17 岁)）进行了 CMR，估计 5 年心源性猝死 (SCD) 风险<6%。2D 和 3D -通过 FT 分析评估了整体径向 (GRS)、纵向 (GLS) 和圆周 (GCS) 应变。该研究的主要结果是主要不良心脏事件 (MACE) 的复合，包括 SCD、因心室颤动导致心脏骤停复苏(VF) 或血流动力学不稳定的室性心动过速 (VT)，以及因心力衰竭住院。

结果

中位随访 51.7 (37.1-68.8) 个月后，4 (3%) 名患者死亡（均患有 SCD），36 名 (28%) 因心力衰竭住院。在对临床和影像协变量进行多变量调整后，在所有应变参数中，只有 GLS 仍然是包括 2D 应变（HR 1.12，95% CI 1.03–1.23，p  = 0.01）在内的模型和包括3D 应变（HR 1.14，95% CI 1.01–1.30，p  = 0.04）。将 2D-GLS 添加到具有临床和影像预测因子的模型中导致 C 统计量显着增加（从 0.48 到 0.65，p  = 0.03）。

结论

CMR-FT 衍生的 GLS 是 HCM 患者 MACE 的一个强大的独立预测因子，增加了常见的临床和 CMR 风险因素，包括左心室射血分数和晚期钆增强。