Cardiac Magnetic Resonance Left Ventricular Mechanical Uniformity Alterations for Risk Assessment After Acute Myocardial Infarction

Thomas Stiermaier, Sören J. Backhaus, Torben Lange, Alexander Koschalka, Jenny Lou Navarra, Patricia Boom, Pablo Lamata, Johannes T. Kowallick, Joachim Lotz, Matthias Gutberlet, Suzanne de Waha-Thiele, Steffen Desch, Gerd Hasenfuß, Holger Thiele, Ingo Eitel*, Andreas Schuster

*Corresponding author for this work

Abstract

Background: Despite limitations as a stand-alone parameter, left ventricular (LV) ejection fraction is the preferred measure of myocardial function and marker for postinfarction risk stratification. LV myocardial uniformity alterations may provide superior prognostic information after acute myocardial infarction, which was the subject of this study. Methods and Results: Consecutive patients with acute myocardial infarction (n=1082; median age: 63 years; 75% male) undergoing cardiac magnetic resonance at a median of 3 days after infarction were included in this multicenter observational study. Circumferential and radial uniformity ratio estimates were derived from cardiac magnetic resonance feature tracking as markers of mechanical uniformity alterations (values between 0 and 1 with 1 reflecting perfect uniformity). The clinical end point was the 12-month rate of major adverse cardiac events, consisting of all-cause death, reinfarction, and new congestive heart failure. Patients with major adverse cardiac events (n=73) had significantly impaired circumferential uniformity ratio estimates (0.76 [interquartile range: 0.67–0.86] versus 0.84 [interquartile range: 0.76–0.89]; P<0.001) and radial uniformity ratio estimates (0.69 [interquartile range: 0.60–0.79] versus 0.76 [interquartile range: 0.67–0.83]; P<0.001) compared with patients without events. Although uniformity estimates did not provide independent prognostic information in the overall cohort, a circumferential uniformity ratio estimate below the median of 0.84 emerged as an independent predictor of outcome in postinfarction patients with LV ejection fraction >35% (n=959), even after adjustment for established risk factors (hazard ratio: 1.99; 95% CI, 1.06–3.74; P=0.033 in multivariable Cox regression analysis). In contrast, LV ejection fraction was not associated with adverse events in this subgroup of patients with acute myocardial infarction. Conclusions: Cardiac magnetic resonance–derived estimates of mechanical uniformity alterations are novel markers for risk assessment after acute myocardial infarction, and the circumferential uniformity ratio estimate provides independent prognostic information for patients with preserved or only moderately reduced LV ejection fraction.

Original languageEnglish
Article numbere011576
JournalJournal of the American Heart Association
Volume8
Issue number16
DOIs
Publication statusPublished - 20.08.2019

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

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