J Cardiovasc Imaging.  2021 Oct;29(4):331-344. 10.4250/jcvi.2020.0216.

Magnetic Resonance Myocardial Feature Tracking in TransfusionDependent Myelodysplastic Syndrome

• Marta AFG
• Ana MG
• Maria DC
• Agustin CMG
• Manuel BP
• Félix LC
• Elena DP
• Pedro LS

• KMID: 2522174
• DOI: http://doi.org/10.4250/jcvi.2020.0216

Abstract

BACKGROUND
Myocardial deformation with echocardiography allows early detection of systolic dysfunction and is related to myocardial iron overload (MIO) determined by T2* in hereditary anemias under transfusion support. Our aim was to analyze the diagnostic and prognostic usefulness of magnetic resonance feature tracking (MR-FT) myocardial strain in low-risk myelodysplastic syndromes (LR-MDS) patients.
METHODS
Prospective study in transfusion-dependent LR-MDS patients and healthy controls who underwent a cardiac MR-FT. We analyzed the relationships between strain MR-FT and iron overload parameters and its prognostic impact in cardiovascular events and/or death.
RESULTS
Thirty-one patients and thirteen controls were included. MIO (T2^* < 20 ms) was detected in 9.7% of patients. Left ventricular global longitudinal strain (LV-GLS) by MRFT was pathological (> −19.3%) in 32.3% of patients. Less negative strain values correlated with lower T2^* (R = −0.37, p = 0.033) and native myocardial T1 (R = −0.39, p = 0.031) times. LV-GLS by MR-FT was significantly associated with higher incidence of the combined cardiovascular events and/or all-cause death (p = 0.047), with a cut-off value of −17.7% for predicting them (63% sensitivity and 81% specificity, area under the curve = 0.69). After adjusting analysis including demographic, biomarkers and imaging variables, a higher LV-GLS value by MR-FT remained as predictor of combined event in transfusion-dependent LR-MDS patients (hazard ratio, 0.4; confidence interval, 0.15–0.98; p = 0.045).
CONCLUSIONS
Longitudinal myocardial strain by MR-FT in LR-MDS patients is associated to MIO and correlates with adverse events in the follow-up, what could serve as a prognostic tool.

Keyword

Myelodysplastic syndrome; Iron overload; Cardiac magnetic resonance; Feature tracking; Myocardial deformation