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

• Kim MY
• Park EA
• Lee W
• Lee SP

• KMID: 2470750
• DOI: http://doi.org/10.3348/kjr.2019.0441

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

Figure

• 

  Fig. 1 Flowchart of study population enrollment. AR = aortic regurgitation, AS = aortic stenosis, CMR = cardiac magnetic resonance, EF = ejection fraction, LV = left ventricle, pEF = preserved EF

• 

  Fig. 2 Assessment of left ventricular myocardial strain using CMR feature tracking software in 72-year-old male with severe AS. A. First step for assessing myocardial strain is defining axis of LV (yellow line), and drawing endocardial (red line) and epicardial (green line) contours on end-diastolic and end-systolic phases, respectively. Phase shown is end-diastolic. B. Second step is visualization of automatic process of myocardial strain measurement. Myocardial points in each slice are connected by visualizing motion lines from end-diastolic to end systolic phases on static systolic 3-chamber-view cine image. C. Third step is automatically obtaining global and segmental strain values (polar maps) and phasic graphs.

• 

  Fig. 3 ROC curve of 2D global longitudinal peak strain for predicting clinical cardiac event in asymptomatic AS patients with pEF. ROC = receiver operating characteristic, 2D = two-dimensional

• 

  Fig. 4 Kaplan-Meier event-free survival curves were stratified by 2D global longitudinal peak strain in asymptomatic AS patients with pEF. For more than −17.9% (n = 22, blue line), median event-free survival period was 53.0 months, while for the others (n = 45, green line), median event-free survival period was 43.3 months (p = 0.041).

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