Korean J Radiol.  2020 Mar;21(3):268-279. 10.3348/kjr.2019.0441.

Cardiac Magnetic Resonance Feature Tracking in Aortic Stenosis: Exploration of Strain Parameters and Prognostic Value in Asymptomatic Patients with Preserved Ejection Fraction

Affiliations
  • 1Department of Radiology, Cardiology Division, Seoul National University Hospital, Seoul, Korea. iameuna1@gmail.com
  • 2Department of Radiology, SNU-SMG Boramae Medical Center, Seoul, Korea.
  • 3Department of Internal Medicine, Cardiology Division, Seoul National University Hospital, Seoul, Korea.

Abstract


OBJECTIVE
To determine the most valuable cardiac magnetic resonance feature tracking (CMR-FT) parameters for evaluating aortic stenosis (AS) and determine whether they can predict the prognosis in asymptomatic AS patients with preserved ejection fraction (pEF).
MATERIALS AND METHODS
A prospective cohort of 123 moderate to severe AS patients (60 males, 68.6 ± 9.2 years) and 32 control subjects (14 males, 67.9 ± 4.4 years) underwent echocardiography and 3T CMR imaging from 2011-2015. CMR cine images were analyzed using CMR-FT to assess the left ventricular radial, circumferential, and longitudinal peak strain (PS) in 2- and 3-dimensions. The primary endpoints were clinical cardiac events (CCEs), including cardiac death, heart failure, and AS-associated symptom development. For statistical analysis, logistic regression and log-rank tests were used.
RESULTS
Global PSs differed between AS patients and controls and between severe and moderate AS patients (p < 0.05). Two-dimensional (2D) global radial and longitudinal PSs changed gradually with the severity of AS groups (p < 0.001). Twenty-two of 67 asymptomatic AS patients with pEF experienced CCEs during the follow-up (median: 31.1 months). 2D global longitudinal PS (GLPS) was the single risk factor for CCE (p = 0.017). The relative risk for CCE was 3.9 (p = 0.016, 95% confidence interval: 1.2-11.9) based on 2D GLPS with a cutoff of −17.9% according to receiver operating characteristic curve analysis. Survival analysis demonstrated that asymptomatic AS patients with pEF having impaired 2D GLPS experienced worse event-free survival than the others (p = 0.041).
CONCLUSION
2D global longitudinal and radial PSs may reflect cardiac dysfunction according to the degree of AS. 2D GLPS might be a prognostic predictor of CCEs in asymptomatic AS patients with pEF.

Keyword

Cardiac magnetic resonance; Feature tracking; Strain; Aortic stenosis; Event-free survival

MeSH Terms

Aortic Valve Stenosis*
Cohort Studies
Death
Disease-Free Survival
Echocardiography
Follow-Up Studies
Heart Failure
Humans
Logistic Models
Male
Prognosis
Prospective Studies
Risk Factors
ROC Curve
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