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Prognostic implications of cardiac magnetic resonance feature tracking derived multidirectional strain in patients with chronic aortic regurgitation

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Abstract

Objective

Speckle-tracking echocardiography (STE) deformation parameters detect latent LV dysfunction in chronic aortic regurgitation (AR) and are associated with outcomes. The aim of the study was to evaluate cardiac magnetic resonance (CMR) feature tracking (FT) deformation parameters in asymptomatic patients with AR and implications in outcomes.

Methods

Fifty-five patients with AR and 54 controls were included. Conventional functional CMR parameters, aortic regurgitant volume, and fraction were assessed. CMR-FT analysis was performed with a dedicated software. Clinical data was obtained from hospital records. A combined endpoint included all-cause mortality, cardiovascular mortality, aortic valve surgery, or cardiovascular hospital admission due to heart failure.

Results

Left ventricular (LV) mechanics is impaired in patients with significant AR. Significant differences were noted in global longitudinal strain (GLS) between controls and AR patients (− 19.1 ± 2.9% vs − 16.5 ± 3.2%, p < 0.001) and among AR severity groups (− 18.3 ± 3.1% vs − 16.2 ± 1.6% vs − 15 ± 3.5%; p = 0.02 for AR grades I–II, III, and IV). In univariate and multivariate analyses, circumferential strain (GCS) and global radial strain (GRS) but not GLS were associated with and increased risk of the end point with a HR of 1.26 (p = 0.016, 1.04–1.52) per 1% worsening for GCS and 0.90 (p = 0.012, 0.83–0.98) per 1% worsening for GRS.

Conclusions

CMR-FT myocardial deformation parameters are impaired in patients with AR not meeting surgical criteria. GLS decreases early in the course of the disease and is a marker of AR severity while GCS and GRS worsen later but predict a bad prognosis, mainly the need of aortic valve surgery.

Key Points

• CMR feature tracking LV mechanic parameters may be reduced in significant chronic AR with normal EF.

• LV mechanics, mainly global longitudinal strain, worsens as AR severity increases.

• LV mechanics, specially global radial and circumferential strain, is associated with a worse prognosis in AR patients.

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Abbreviations

AR:

Aortic regurgitation

CMR:

Cardiac magnetic resonance

CMR-FT:

Cardiac magnetic resonance feature tracking

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

GRS:

Global radial strain

LV:

Left ventricle

RF:

Regurgitant fraction

RV:

Regurgitant volume

STE:

Speckle-tracking echocardiography

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar km 9, 100 28034, Madrid, Spain

    Covadonga Fernández-Golfín, Rocío Hinojar-Baydes, Ariana González-Gómez, Juan Manuel Monteagudo, Gonzalo Alonso-Salinas, Ana García-Martín, Ciro Santoro, Marina Pascual-Izco, Jose Julio Jiménez-Nacher & Jose Luis Zamorano

  2. CIBERCV, Instituto de Salud Carlos III (ISCIII), Majadahonda, Spain

    Covadonga Fernández-Golfín & Jose Luis Zamorano

  3. Radiology Department, University Hospital Ramón y Cajal, Madrid, Spain

    Amparo Esteban & Maria Angeles Fernández

Authors
  1. Covadonga Fernández-Golfín
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  2. Rocío Hinojar-Baydes
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  3. Ariana González-Gómez
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  4. Juan Manuel Monteagudo
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  8. Ana García-Martín
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  9. Ciro Santoro
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  10. Marina Pascual-Izco
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Corresponding author

Correspondence to Covadonga Fernández-Golfín.

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Guarantor

The scientific guarantor of this publication is Covadonga Fernández-Golfín.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported: Hinojar R, Fernández-Golfín C, González-Gómez A et al. Prognostic implications of global myocardial mechanics in hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking. Relations to left ventricular hypertrophy and fibrosis. Int J Cardiol. 2017: 249: 467-72.

Methodology

• retrospective

• diagnostic or prognostic study/observational

• performed at one institution

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Fernández-Golfín, C., Hinojar-Baydes, R., González-Gómez, A. et al. Prognostic implications of cardiac magnetic resonance feature tracking derived multidirectional strain in patients with chronic aortic regurgitation. Eur Radiol 31, 5106–5115 (2021). https://doi.org/10.1007/s00330-020-07651-6

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  • DOI: https://doi.org/10.1007/s00330-020-07651-6

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