PMID- 25890580 OWN - NLM STAT- MEDLINE DCOM- 20160201 LR - 20220408 IS - 1876-7591 (Electronic) IS - 1876-7591 (Linking) VI - 8 IP - 5 DP - 2015 May TI - The Combined Incremental Prognostic Value of LVEF, Late Gadolinium Enhancement, and Global Circumferential Strain Assessed by CMR. PG - 540-549 LID - S1936-878X(15)00130-8 [pii] LID - 10.1016/j.jcmg.2015.02.005 [doi] AB - OBJECTIVES: This study aimed to assess the incremental prognostic value of global circumferential strain (GCS), as measured using cardiac magnetic resonance (CMR) tagging, in addition to baseline clinical characteristics, left ventricular ejection fraction (LVEF), and late gadolinium enhancement (LGE), in the prediction of major adverse cardiovascular events (MACE) in an unselected cohort of patients. BACKGROUND: LVEF is a powerful predictor of mortality and is used for guiding treatment decisions. It is, however, subject to limitations. The value of GCS measured by CMR tagging in patients with suspected cardiac disease has not been fully explored despite its being considered as the gold standard noninvasive method of assessment of LV deformation. METHODS: We prospectively evaluated data from 539 consecutive patients referred for CMR who underwent a CMR protocol that included cine imaging, tagging, and LGE. The primary endpoint was the prevalence of MACE, defined as a composite of all-cause mortality, heart failure-related hospitalization, and aborted sudden cardiac death. RESULTS: MACE occurred in 62 of 539 patients (11.5%) over a mean follow-up period of 2.2 years. History of ischemic heart disease (IHD) and beta-blocker use were both significant clinical predictors of adverse outcomes. All 3 CMR parameters were significant multivariate predictors of the primary outcome when added to significant clinical predictors (LVEF, hazard ratio [HR]: 0.96 [95% confidence interval [CI]: 0.94 to 0.99; p = 0.005]; presence of LGE, HR: 2.07 [95% CI: 1.03 to 4.14; p = 0.04]; GCS, HR: 1.11 [95% CI: 1.02 to 1.21; p = 0.041]). Global chi-square increased significantly with the addition of both LGE and GCS. Both the presence of LGE and reduced GCS had independent prognostic value in the overall cohort. Patients with LVEF >/=35% but LGE present and reduced GCS had a poor outcome similar to that in those with LVEF <35%. CONCLUSIONS: We found, in a large-scale cohort of patients, that GCS, in addition to clinical variables, LVEF, and LGE, had incremental independent prognostic value. This measure could provide further risk stratification, especially in patients with mild LV impairment. CI - Copyright (c) 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Mordi, Ify AU - Mordi I AD - British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom. Electronic address: ifyrmordi@doctors.org.uk. FAU - Bezerra, Hiram AU - Bezerra H AD - Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio. FAU - Carrick, David AU - Carrick D AD - British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom. FAU - Tzemos, Nikolaos AU - Tzemos N AD - British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom. LA - eng PT - Journal Article DEP - 20150415 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 RN - 0 (Contrast Media) RN - K2I13DR72L (Gadolinium DTPA) SB - IM CIN - JACC Cardiovasc Imaging. 2015 May;8(5):550-2. PMID: 25937193 MH - Adult MH - Biomechanical Phenomena MH - Chi-Square Distribution MH - *Contrast Media MH - Death, Sudden, Cardiac/epidemiology/prevention & control MH - Disease Progression MH - Female MH - *Gadolinium DTPA MH - Heart Diseases/*diagnosis/mortality/physiopathology/therapy MH - Heart Failure/diagnosis/mortality/physiopathology MH - Humans MH - Kaplan-Meier Estimate MH - *Magnetic Resonance Imaging, Cine MH - Male MH - Middle Aged MH - Multivariate Analysis MH - *Myocardial Contraction MH - Predictive Value of Tests MH - Prevalence MH - Prognosis MH - Proportional Hazards Models MH - Prospective Studies MH - Risk Factors MH - *Stroke Volume MH - Time Factors MH - Ventricular Dysfunction, Left/diagnosis/mortality/physiopathology MH - *Ventricular Function, Left OTO - NOTNLM OT - cardiac magnetic resonance OT - late gadolinium enhancement OT - strain OT - tagging EDAT- 2015/04/22 06:00 MHDA- 2016/02/02 06:00 CRDT- 2015/04/20 06:00 PHST- 2014/11/07 00:00 [received] PHST- 2015/02/11 00:00 [revised] PHST- 2015/02/12 00:00 [accepted] PHST- 2015/04/20 06:00 [entrez] PHST- 2015/04/22 06:00 [pubmed] PHST- 2016/02/02 06:00 [medline] AID - S1936-878X(15)00130-8 [pii] AID - 10.1016/j.jcmg.2015.02.005 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2015 May;8(5):540-549. doi: 10.1016/j.jcmg.2015.02.005. Epub 2015 Apr 15.