Diagnostic and Prognostic Value of Long-Axis Strain and Myocardial Contraction Fraction Using Standard Cardiovascular MR Imaging in Patients with Nonischemic Dilated Cardiomyopathies.

Purpose To assess the utility of established functional markers versus two additional functional markers derived from standard cardiovascular magnetic resonance (MR) images for their incremental diagnostic and prognostic information in patients with nonischemic dilated cardiomyopathy (NIDCM). Materials and Methods Approval was obtained from the local ethics committee. MR images from 453 patients with NIDCM and 150 healthy control subjects were included between 2005 and 2013 and were analyzed retrospectively. Myocardial contraction fraction (MCF) was calculated by dividing left ventricular (LV) stroke volume by LV myocardial volume, and long-axis strain (LAS) was calculated from the distances between the epicardial border of the LV apex and the midpoint of a line connecting the origins of the mitral valve leaflets at end systole and end diastole. Receiver operating characteristic curve, Kaplan-Meier method, Cox regression, and classification and regression tree (CART) analyses were performed for diagnostic and prognostic performances. Results LAS (area under the receiver operating characteristic curve [AUC] = 0.93, P < .001) and MCF (AUC = 0.92, P < .001) can be used to discriminate patients with NIDCM from age- and sex-matched control subjects. A total of 97 patients reached the combined end point during a median follow-up of 4.8 years. In multivariate Cox regression analysis, only LV ejection fraction (EF) and LAS independently indicated the combined end point (hazard ratio = 2.8 and 1.9, respectively; P < .001 for both). In a risk stratification approach with classification and regression tree analysis, combined LV EF and LAS cutoff values were used to stratify patients into three risk groups (log-rank test, P < .001). Conclusion Cardiovascular MR-derived MCF and LAS serve as reliable diagnostic and prognostic markers in patients with NIDCM. LAS, as a marker for longitudinal contractile function, is an independent parameter for outcome and offers incremental information beyond LV EF and the presence of myocardial fibrosis. © RSNA, 2017 Online supplemental material is available for this article.

[1]  H. Katus,et al.  Left ventricular long axis strain: a new prognosticator in non-ischemic dilated cardiomyopathy? , 2016, Journal of Cardiovascular Magnetic Resonance.

[2]  Vibhav Rangarajan,et al.  Left ventricular long axis function assessed during cine-cardiovascular magnetic resonance is an independent predictor of adverse cardiac events , 2016, Journal of Cardiovascular Magnetic Resonance.

[3]  E. Nagel,et al.  T1-Mapping and Outcome in Nonischemic Cardiomyopathy: All-Cause Mortality and Heart Failure. , 2016, JACC. Cardiovascular imaging.

[4]  H. Katus,et al.  Fast assessment of long axis strain with standard cardiovascular magnetic resonance: a validation study of a novel parameter with reference values , 2015, Journal of Cardiovascular Magnetic Resonance.

[5]  H. Katus,et al.  Age- and gender-related normal left ventricular deformation assessed by cardiovascular magnetic resonance feature tracking , 2015, Journal of Cardiovascular Magnetic Resonance.

[6]  A. Voss,et al.  Assessment of myocardial deformation with cardiac magnetic resonance strain imaging improves risk stratification in patients with dilated cardiomyopathy. , 2015, European heart journal cardiovascular Imaging.

[7]  M. Maurer,et al.  The myocardial contraction fraction is superior to ejection fraction in predicting survival in patients with AL cardiac amyloidosis , 2015, Amyloid : the international journal of experimental and clinical investigation : the official journal of the International Society of Amyloidosis.

[8]  Petr Otahal,et al.  Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction , 2014, Heart.

[9]  D. Bluemke,et al.  Prognostic value of myocardial circumferential strain for incident heart failure and cardiovascular events in asymptomatic individuals: the Multi-Ethnic Study of Atherosclerosis. , 2013, European heart journal.

[10]  Peter Søgaard,et al.  Prediction of all-cause mortality and heart failure admissions from global left ventricular longitudinal strain in patients with acute myocardial infarction and preserved left ventricular ejection fraction. , 2013, Journal of the American College of Cardiology.

[11]  James D. Thomas,et al.  Incremental prognostic value of assessing left ventricular myocardial mechanics in patients with chronic systolic heart failure. , 2012, Journal of the American College of Cardiology.

[12]  A. Voss,et al.  Longitudinal left ventricular function for prediction of survival in systemic light-chain amyloidosis: incremental value compared with clinical and biochemical markers. , 2012, Journal of the American College of Cardiology.

[13]  D. Levy,et al.  Usefulness of the left ventricular myocardial contraction fraction in healthy men and women to predict cardiovascular morbidity and mortality. , 2012, The American journal of cardiology.

[14]  Jeroen J. Bax,et al.  Global Longitudinal Strain Predicts Long-Term Survival in Patients With Chronic Ischemic Cardiomyopathy , 2012, Circulation. Cardiovascular imaging.

[15]  J. Moon,et al.  Cardiomyopathies: focus on cardiovascular magnetic resonance. , 2011, The British journal of radiology.

[16]  P. Poole‐Wilson,et al.  Role of Cardiovascular Magnetic Resonance as a Gatekeeper to Invasive Coronary Angiography in Patients Presenting With Heart Failure of Unknown Etiology , 2011, Circulation.

[17]  N. Osman,et al.  Strain-encoded cardiac magnetic resonance during high-dose dobutamine stress testing for the estimation of cardiac outcomes. Comparison to clinical parameters and conventional wall motion readings , 2011, Journal of the American College of Cardiology.

[18]  H. Katus,et al.  Use of cardiovascular magnetic resonance for risk stratification in chronic heart failure: prognostic value of late gadolinium enhancement in patients with non-ischaemic dilated cardiomyopathy , 2010, Heart.

[19]  J. Francis,et al.  The role of cardiovascular magnetic resonance imaging in heart failure. , 2009, Journal of the American College of Cardiology.

[20]  Thomas H. Marwick,et al.  Prediction of All-Cause Mortality From Global Longitudinal Speckle Strain: Comparison With Ejection Fraction and Wall Motion Scoring , 2009, Circulation. Cardiovascular imaging.

[21]  Dong-Jin Oh,et al.  Global 2-dimensional strain as a new prognosticator in patients with heart failure. , 2009, Journal of the American College of Cardiology.

[22]  S. Dymarkowski,et al.  The role of cardiovascular magnetic resonance in the diagnosis and management of cardiomyopathies. , 2008, Journal of cardiovascular medicine.

[23]  Eloisa Arbustini,et al.  Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. , 2007, European heart journal.

[24]  B. Sveälv,et al.  Ventricular long-axis function is of major importance for long-term survival in patients with heart failure , 2007, Heart.

[25]  Dudley J Pennell,et al.  Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. , 2006, Journal of the American College of Cardiology.

[26]  Barry J Maron,et al.  Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interd , 2006, Circulation.

[27]  C H Lorenz,et al.  Differentiation of Heart Failure Related to Dilated Cardiomyopathy and Coronary Artery Disease Using Gadolinium‐Enhanced Cardiovascular Magnetic Resonance , 2003, Circulation.

[28]  Dudley J Pennell,et al.  Left Ventricular Mass: Reliability of M-Mode and 2-Dimensional Echocardiographic Formulas , 2002, Hypertension.

[29]  D. King,et al.  Myocardial contraction fraction: a volumetric index of myocardial shortening by freehand three-dimensional echocardiography. , 2002, Journal of the American College of Cardiology.

[30]  D. Pennell,et al.  Comparison of interstudy reproducibility of cardiovascular magnetic resonance with two-dimensional echocardiography in normal subjects and in patients with heart failure or left ventricular hypertrophy. , 2002, The American journal of cardiology.

[31]  Wojciech Zareba,et al.  Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. , 2002, The New England journal of medicine.

[32]  F. Schiele,et al.  Lack of Agreement Between Left Ventricular Volumes and Ejection Fraction Determined by Two‐Dimensional Echocardiography and Contrast Cineangiography in Postinfarction Patients , 2001, Echocardiography.

[33]  D J Pennell,et al.  Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable? , 2000, European heart journal.

[34]  B. Wandt.  Long-axis contraction of the ventricles: a modern approach, but described already by Leonardo da Vinci. , 2000, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[35]  ICHAEL,et al.  UNDERLYING CAUSES AND LONG-TERM SURVIVAL IN PATIENTS WITH INITIALLY UNEXPLAINED CARDIOMYOPATHY , 2000 .

[36]  Patrice Degoulet,et al.  Models to predict cardiovascular risk: comparison of CART, multilayer perceptron and logistic regression , 2000, AMIA.

[37]  A J Tajik,et al.  Two-Dimensional and Doppler Echocardiography Alone Can Adequately Define Preoperative Anatomy and Hemodynamic Status before Repair of Complete Atrioventricular Septal Defect in Infants <1 Year Old , 1994, Circulation.

[38]  N. Schiller,et al.  Reproducibility of quantitative two-dimensional echocardiography. , 1988, American heart journal.

[39]  N. Reichek,et al.  Anatomic Validation of Left Ventricular Mass Estimates from Clinical Two‐dimensional Echocardiography: Initial Results , 1983, Circulation.