Extracellular Volume and Global Longitudinal Strain Both Associate With Outcomes But Correlate Minimally
| Autor: | Ali A. Azeem, Yaron Fridman, Javed Butler, Martin Ugander, Louise Niklasson, Miho Fukui, Christopher A. Miller, Adam Christopher, Patrick Bering, Fredrika Fröjdh, Eric Olausson, Peter Kellman, Hongyang Pi, Brian Feingold, Maren Maanja, Timothy C. Wong, Aatif Sayeed, Erik B. Schelbert, João L. Cavalcante |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Magnetic Resonance Imaging Cine 030204 cardiovascular system & hematology Ventricular Function Left 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Internal medicine Linear regression Extracellular fluid Medicine Humans Radiology Nuclear Medicine and imaging Adverse effect Heart Failure medicine.diagnostic_test business.industry Proportional hazards model Myocardium Hazard ratio Magnetic resonance imaging Heart Stroke Volume medicine.disease Heart failure Cohort Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | JACC. Cardiovascular imaging. 13(11) |
| ISSN: | 1876-7591 |
| Popis: | Objectives This study examined how ECV and GLS relate to each other and to outcomes. Background Among myriad changes occurring in diseased myocardium, left ventricular imaging metrics of either the interstitium (e.g., extracellular volume [ECV]) or contractile function (e.g., global longitudinal strain [GLS]) may consistently associate with adverse outcomes yet correlate minimally with each other. This scenario suggests that ECV and GLS potentially represent distinct domains of cardiac vulnerability. Methods The study included 1,578 patients referred for cardiovascular magnetic resonance (CMR) without amyloidosis, and it quantified how ECV associated with GLS in linear regression models. ECV and GLS were then compared in their associations with incident outcomes (death and hospitalization for heart failure). Results ECV and GLS correlated minimally (R2 = 0.04). Over a median follow-up of 5.6 years, 339 patients experienced adverse events (149 hospitalizations for heart failure, 253 deaths, and 63 with both). GLS (univariable hazard ratio: 2.07 per 5% increment; 95% CI: 1.86 to 2.29) and ECV (univariable hazard ratio: 1.66 per 4% increment; 95% CI: 1.51 to 1.82) were principal variables associating with outcomes in univariable and multivariable Cox regression models. Similar results were observed in several clinically important subgroups. In the whole cohort, ECV added prognostic value beyond GLS in univariable and multivariable Cox regression models. Conclusions GLS and ECV may represent principal but distinct domains of cardiac vulnerability, perhaps reflecting their distinct cellular origins. Whether combining ECV and GLS may advance pathophysiological understanding for a given patient, optimize risk stratification, and foster personalized medicine by targeted therapeutics requires further investigation. |
| Databáze: | OpenAIRE |
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