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Impaired left-ventricular global longitudinal strain by feature-tracking cardiac MRI predicts mortality in systemic sclerosis

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Abstract

Impaired left-ventricular (LV) and right-ventricular (RV) cardiac magnetic resonance (CMR) strain has been documented in systemic sclerosis (SSc). However, it is unknown whether the CMR strain is predictive of adverse outcomes in SSc. Therefore, we set out to investigate the prognostic value of CMR strain in SSc. Patients with SSc who underwent CMR for clinical indications between 11/2010 and 07/2020 were retrospectively studied. LV and RV strain was evaluated by feature tracking. The association between strain, late gadolinium enhancement (LGE), and survival was evaluated with time to event and Cox-regression analyses. During the study period, 42 patients with SSc (age: 57 ± 14 years, 83% female, 57% limited cutaneous SSc, SSc duration: 7 ± 8 years) underwent CMR. During the median follow-up of 3.6 years, 11 patients died (26%). Compared to surviving patients, patients who died had significantly worse LV GLS (− 8.2 ± 6.2% versus − 12.1 ± 2.9%, p = 0.03), but no difference in LV global radial, circumferential, or RV strain values. Patients within the quartile of most impaired LV GLS (≥ − 12.8%, n = 10) had worse survival when compared to patients with preserved LV GLS (< − 12.8%, n = 32, log-rank p = 0.02), which persisted after controlling for LV cardiac output, LV cardiac index, reduced LV ejection fraction, or presence of LGE. In addition, patients who had both impaired LV GLS and LGE (n = 5) had worse survival than patients with LGE or impaired GLS alone (n = 14) and compared to those without any of these features (n = 17, p = 0.003). In our retrospective cohort of patients with SSc undergoing CMR for clinical indications, LV GLS and LGE were found to be predictive of overall survival.

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Data availability

The authors confirm that the data in the present study are available within the article and supplementary materials. Raw data are available on request from the corresponding author.

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Funding

This research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH) under Award No. R01 AR073270 (MH) and by the National Center for Advancing Translational Science under Award No. UL1 TR001863 (LAB).

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Authors and Affiliations

  1. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P. O. Box 208017, Dana 3, New Haven, CT, 06520, USA

    Attila Feher, Edward J. Miller, Albert J. Sinusas & Lauren A. Baldassarre

  2. Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA

    Attila Feher, Edward J. Miller, Dana C. Peters, Hamid R. Mojibian, Albert J. Sinusas & Lauren A. Baldassarre

  3. Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Monique Hinchcliff

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Contributions

AF and LAB conceived this study, collection of data, and critical review of the manuscript: AF, EJM, DCP, HRM, AJS, MH, and LAB; AF analyzed data, drafted the manuscript, and designed the figures. All authors have read and approved the final manuscript. All authors take full responsibility for the integrity of all aspects of the work.

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Correspondence to Attila Feher.

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Feher, A., Miller, E.J., Peters, D.C. et al. Impaired left-ventricular global longitudinal strain by feature-tracking cardiac MRI predicts mortality in systemic sclerosis. Rheumatol Int 43, 849–858 (2023). https://doi.org/10.1007/s00296-023-05294-6

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