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Prognostic Value of Strain in Vasodilator Stress MRI
Study Questions:
What is the prognostic value of global longitudinal strain (GLS) during vasodilator stress cardiac magnetic resonance imaging (MRI)?
Methods:
This study examined 535 individuals undergoing regadenoson stress MRI, and performed feature-tracking stress GLS immediately after perfusion imaging. The prognostic value of GLS was assessed for adverse events (death, myocardial infarction, heart failure hospitalization, sustained ventricular tachycardia, and late revascularization).
Results:
A total of 82 subjects had adverse events over a median follow-up of 1.5 years. A stress GLS worse than the median value (-19%) was associated with increased adverse events (p < 0.001). After adjusting for clinical and imaging factors, stress GLS was independently associated with adverse events (27% increase in risk per % worsening in GLS; p < 0.001). The addition of stress GLS to a model with clinical and imaging predictors of adverse events increased the c-index from 0.80 to 0.85 (p = 0.03). In the subgroup without ischemia on first-pass perfusion, a GLS worse than the median value was also associated with increased adverse events (p < 0.001).
Conclusions:
Stress GLS is independently associated with the rate adverse events in patients with known or suspected coronary artery disease undergoing vasodilator stress MRI. Stress GLS may provide incremental data that helps improve risk stratification in patients undergoing stress MRI.
Perspective:
Abnormal GLS during dobutamine stress echocardiography has been reported to be associated with increased adverse events, and similar observations have been reported with dobutamine stress MRI. This study examined the prognostic value of stress GLS during vasodilator stress MRI and demonstrated that worse stress GLS is associated with increased adverse events. These findings suggest that stress GLS on vasodilator stress MRI may improve our ability to identify patients at increased risk of adverse events and may be additive to current stress protocols. Of note, abnormal stress GLS was also associated with increased adverse events in the subgroup without ischemia on stress MRI, and further research is needed to determine whether additional testing or treatment changes would be clinically helpful in this cohort.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), SCD/Ventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and Coronary Artery Disease, Interventions and Imaging, Echocardiography/Ultrasound, Magnetic Resonance Imaging, Nuclear Imaging
Keywords: Coronary Artery Disease, Diagnostic Imaging, Dobutamine, Echocardiography, Stress, Heart Failure, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Perfusion Imaging, Tachycardia, Ventricular, Vasodilator Agents
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