PMID- 35680209
OWN - NLM
STAT- MEDLINE
DCOM- 20220613
LR  - 20230110
IS  - 1876-7591 (Electronic)
IS  - 1876-7591 (Linking)
VI  - 15
IP  - 6
DP  - 2022 Jun
TI  - Left Atrial Strain Has Superior Prognostic Value to Ventricular Function and 
      Delayed-Enhancement in Dilated Cardiomyopathy.
PG  - 1015-1026
LID - S1936-878X(22)00101-2 [pii]
LID - 10.1016/j.jcmg.2022.01.016 [doi]
AB  - BACKGROUND: The left atrium is an early sensor of left ventricular (LV) 
      dysfunction. Still, the prognostic value of left atrial (LA) function (strain) on 
      cardiac magnetic resonance (CMR) in dilated cardiomyopathy (DCM) remains unknown. 
      OBJECTIVES: The goal of this study was to evaluate the prognostic value of 
      CMR-derived LA strain in DCM. METHODS: Patients with DCM from the Maastricht 
      Cardiomyopathy Registry with available CMR imaging were included. The primary 
      endpoint was the combination of sudden or cardiac death, heart failure (HF) 
      hospitalization, or life-threatening arrhythmias. Given the nonlinearity of 
      continuous variables, cubic spline analysis was performed to dichotomize. 
      RESULTS: A total of 488 patients with DCM were included (median age: 54 [IQR: 
      46-62] years; 61% male). Seventy patients (14%) reached the primary endpoint 
      (median follow-up: 6 [IQR: 4-9] years). Age, New York Heart Association (NYHA) 
      functional class >II, presence of late gadolinium enhancement (LGE), LV ejection 
      fraction (LVEF), LA volume index (LAVI), LV global longitudinal strain (GLS), and 
      LA reservoir and conduit strain were univariably associated with the outcome (all 
      P < 0.02). LA conduit strain was a stronger predictor of outcome compared with 
      reservoir strain. LA conduit strain, NYHA functional class >II, and LGE remained 
      associated in the multivariable model (LA conduit strain HR: 3.65 [95% CI: 
      2.01-6.64; P < 0.001]; NYHA functional class >II HR: 1.81 [95% CI: 1.05-3.12; P = 
      0.033]; and LGE HR: 2.33 [95% CI: 1.42-3.85; P < 0.001]), whereas age, N-terminal 
      pro-B-type natriuretic peptide, LVEF, left atrial ejection fraction, LAVI, and LV 
      GLS were not. Adding LA conduit strain to other independent predictors (NYHA 
      functional class and LGE) significantly improved the calibration, accuracy, and 
      reclassification of the prediction model (P < 0.05). CONCLUSIONS: LA conduit 
      strain on CMR is a strong independent prognostic predictor in DCM, superior to LV 
      GLS, LVEF, and LAVI and incremental to LGE. Including LA conduit strain in DCM 
      patient management should be considered to improve risk stratification.
CI  - Copyright (c) 2022 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Raafs, Anne G
AU  - Raafs AG
AD  - Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht 
      University Medical Center, Maastricht, the Netherlands. Electronic address: 
      anne.raafs@mumc.nl.
FAU - Vos, Jacqueline L
AU  - Vos JL
AD  - Department of Cardiology, Radboud University Medical Center, Nijmegen, the 
      Netherlands.
FAU - Henkens, Michiel T H M
AU  - Henkens MTHM
AD  - Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht 
      University Medical Center, Maastricht, the Netherlands; Netherlands Heart 
      Institute (NLHI), Utrecht, the Netherlands.
FAU - Slurink, Bram O
AU  - Slurink BO
AD  - Department of Cardiology, Radboud University Medical Center, Nijmegen, the 
      Netherlands.
FAU - Verdonschot, Job A J
AU  - Verdonschot JAJ
AD  - Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht 
      University Medical Center, Maastricht, the Netherlands; Department of Clinical 
      Genetics, Maastricht University Medical Center, Maastricht, the Netherlands.
FAU - Bossers, Daan
AU  - Bossers D
AD  - Department of Cardiology, Radboud University Medical Center, Nijmegen, the 
      Netherlands.
FAU - Roes, Kit
AU  - Roes K
AD  - Department of Health Evidence, Radboud University Medical Center, Nijmegen, the 
      Netherlands.
FAU - Gerretsen, Suzanne
AU  - Gerretsen S
AD  - Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute 
      Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the 
      Netherlands.
FAU - Knackstedt, Christian
AU  - Knackstedt C
AD  - Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht 
      University Medical Center, Maastricht, the Netherlands.
FAU - Hazebroek, Mark R
AU  - Hazebroek MR
AD  - Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht 
      University Medical Center, Maastricht, the Netherlands.
FAU - Nijveldt, Robin
AU  - Nijveldt R
AD  - Department of Cardiology, Radboud University Medical Center, Nijmegen, the 
      Netherlands.
FAU - Heymans, Stephane R B
AU  - Heymans SRB
AD  - Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht 
      University Medical Center, Maastricht, the Netherlands; Department of 
      Cardiovascular Research, University of Leuven, Leuven, Belgium.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220511
PL  - United States
TA  - JACC Cardiovasc Imaging
JT  - JACC. Cardiovascular imaging
JID - 101467978
RN  - 0 (Contrast Media)
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
CIN - JACC Cardiovasc Imaging. 2022 Jun;15(6):1027-1029. PMID: 35680210
CIN - JACC Cardiovasc Imaging. 2022 Dec;15(12):2155-2156. PMID: 36481087
CIN - JACC Cardiovasc Imaging. 2022 Dec;15(12):2156-2157. PMID: 36481088
MH  - *Cardiomyopathy, Dilated
MH  - Contrast Media
MH  - Female
MH  - Gadolinium
MH  - Heart Atria
MH  - Humans
MH  - Magnetic Resonance Imaging, Cine
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Stroke Volume
MH  - *Ventricular Dysfunction, Left
MH  - Ventricular Function, Left
OTO - NOTNLM
OT  - cardiac MRI
OT  - dilated cardiomyopathy
OT  - feature tracking strain
OT  - left atrial phasic function
OT  - prognosis
COIS- Funding Support and Author Disclosures This study was supported by the 
      Netherlands Cardiovascular Research Initiative, an initiative with support of the 
      Dutch Heart Foundation, CVON She-PREDICTS, grant 2017-21, CVON-DCVA Double Dosis 
      2021. Dr Heymans has provided current and previous scientific advice to 
      AstraZeneca, CellProthera, Novo Nordisk, Bayer, Pfizer, CSL Behring, and Merck on 
      heart failure and cardiomyopathies. All other authors have reported that they 
      have no relationships relevant to the contents of this paper to disclose.
EDAT- 2022/06/10 06:00
MHDA- 2022/06/14 06:00
CRDT- 2022/06/09 21:03
PHST- 2021/11/02 00:00 [received]
PHST- 2022/01/01 00:00 [revised]
PHST- 2022/01/24 00:00 [accepted]
PHST- 2022/06/09 21:03 [entrez]
PHST- 2022/06/10 06:00 [pubmed]
PHST- 2022/06/14 06:00 [medline]
AID - S1936-878X(22)00101-2 [pii]
AID - 10.1016/j.jcmg.2022.01.016 [doi]
PST - ppublish
SO  - JACC Cardiovasc Imaging. 2022 Jun;15(6):1015-1026. doi: 
      10.1016/j.jcmg.2022.01.016. Epub 2022 May 11.