Journal
JACC-CARDIOVASCULAR IMAGING
Volume 13, Issue 11, Pages 2343-2354Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcmg.2020.04.026
Keywords
cardiac magnetic resonance; extracellular volume; global longitudinal strain; interstitium; myocardial fibrosis
Funding
- Clinician Scientist Award from the National Institute for Health (NIH) Research [CS-2015-15-003]
- American Heart Association Scientist Development grant
- Children's Cardiomyopathy Foundation grant
- American Heart Association Enduring Hearts grant [14GRNT20380101]
- National Center for Advancing Translational Sciences of the NIH [KL2TR000146]
- Pittsburgh Foundation [M2009-0068]
- American Heart Association Scientist Development grant [09SDG2180083]
- T. Franklin Williams Scholarship Award
- Atlantic Philanthropies, Inc.
- John A. Hartford Foundation
- Association of Specialty Professors
- American Heart Association
- National Center for Research Resources, a component of the NIH [UL1-TR-001857]
- NIH Roadmap for Medical Research
- Swedish Research Council
- Swedish Heart and Lung Foundation
- Stockholm County Council
- Karolinska Institutet
- Roche
- Guerbet
- Abbott Vascular
- Edwards Lifesciences
- Medtronic
- Boston Scientific
- Circle Cardiovascular Imaging
- Siemens Healthineers
- Medis
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OBJECTIVES This study examined how extracellular volume (ECV) and global longitudinal strain (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., ECV) or contractile function (e.g., 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 (R-2 = 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. (C) 2020 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.
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