Right ventricular global longitudinal strain > -23.2% was an independent predictor of major adverse cardiac events in patients with reduced ejection fraction (aHR 1.27; 95% CI 1.00-1.61; p<0.049).
Cohort (n=1,810)
Yes
Does CMR-FT derived RV GLS predict major adverse cardiac events in patients with reduced ejection fraction?
CMR-FT derived RV GLS provides independent prognostic value for predicting mortality and heart failure in patients with reduced ejection fraction beyond standard clinical and imaging parameters.
Hazard Ratio: 1.27 (95% CI 1–1.61)
p-value: p=<0.049
Abstract Background The left ventricular global longitudinal strain (GLS) is recognized as an additional prognostic marker in patients with reduced ejection fraction on top of traditional imaging parameters. However, less is known about the role of right ventricular global longitudinal strain (RV GLS) assessed with cardiac magnetic resonance feature tracking (CMR-FT). Purpose The aim of this study is to assess the prognostic value of CMR-FT derived RV GLS in a cohort of patients with ischemic (ICM) and non-ischemic cardiomyopathy (NICM) and reduced left ventricular ejection fraction (LVEF). Methods Patients from the DERIVATE registry, an international, multicenter, and multivendor study with LVEF 50% were included. All patients underwent CMR with RV GLS assessment. Major adverse cardiac events (MACE) were defined as all-cause mortality (ACM) or heart failure (HF). Univariable and multivariable Cox regression models were used to estimate adjusted hazard ratio (aHR) with 95% confidence intervals (95% CI) for RV GLS to predict MACE. Time-dependent receiver operating characteristic analysis was performed to identify the best cutoff for predicting 5-year outcomes. Results 1810 patients (mean age 60 ± 14 years, male 76%) were included. The median follow-up was 1006 days (578 – 1577 days). 455 patients (25%) experienced MACE. Mean RV GLS was - 19.6 ± 6%. Patients who experienced MACE had a higher RV GLS in comparison with patients without events (- 18.4 ± 6% vs - 19.9 ± 6%, p 0.001). The best cut-off in the prediction of MACE was RV GLS - 23.2%, with an area under curve (AUC) of 0.6. After adjustment for clinical (age, diabetes, atrial fibrillation, NYHA class III-IV) and standard CMR parameters (RV dimensions, LVEF and presence of late gadolinium enhancement), RV GLS - 23.2% remained as an independent predictor of MACE (aHR 1.27, 95% CI 1.00 – 1.61, p 0.049). Conclusions CMR-FT RV GLS is an independent predictor of ACM or HF on top of standard clinical and imaging parameters in both NICM and ICM. A cut-off of - 23.2% identifies high-risk patients that may require further clinical evaluation.
Ciarlantini et al. (Thu,) conducted a cohort in Ischemic and non-ischemic cardiomyopathy with reduced LVEF (n=1,810). Right ventricular global longitudinal strain (RV GLS) > -23.2% vs. RV GLS ≤ -23.2% was evaluated on Major adverse cardiac events (MACE) defined as all-cause mortality or heart failure (aHR 1.27, 95% CI 1.00-1.61, p=<0.049). Right ventricular global longitudinal strain > -23.2% was an independent predictor of major adverse cardiac events in patients with reduced ejection fraction (aHR 1.27; 95% CI 1.00-1.61; p<0.049).