Prognostic Value of Segmental Strain After ST ‐Elevation Myocardial Infarction: Insights From the EARLY Assessment of MYOcardial Tissue Characteristics by Cardiac Magnetic Resonance (EARLY‐MYO‐CMR ) Study
Jie He, Lingcong Kong, Dongaolei An, Binghua Chen, Chengxu Zhao, Zheng Li, Fan Yang, Jianxun Dong, Lai Wei, Peiren Shan, Yingmin Chen, Lianming Wu, Jianrong Xu, Heng Ge, Jun Pu - Radiology, Nuclear Medicine and imaging
Background
The prognostic value of left ventricular segmental strain (SS) in ST‐elevation myocardial infarction (STEMI) remains unclear.
Hypothesis
To assess the prognostic value and application of SS.
Study Type
Retrospective analysis of a prospective registry.
Population
Five hundred and forty‐four patients after STEMI (500 in Cohort 1, 44 in Cohort 2).
Field Strength/Sequence
3 T, balanced steady‐state free precession, gradient echo, and gradient echo contrast‐enhanced images.
Assessment
Participants underwent cardiac MR during the acute phase after STEMI. Infarct‐related artery (IRA) strain was determined based on SS obtained from cine images. The primary endpoint was the composite of major adverse cardiovascular events (MACEs) after 8 years of follow‐up. In Cohort 2, SS stability was assessed by MR twice within 8 days. Contrast and non‐contrast risk models based on SS were established, leading to the development of an algorithm.
Statistical Test
Student's t‐test, Mann–Whitney U‐test, Cox and logistic regression, Kaplan–Meier analysis, net reclassification index (NRI). P < 0.05 was considered significant.
Results
During a median follow‐up of 5.2 years, 83 patients from Cohort 1 experienced a MACE. Among SS, IRA peak circumferential strain (IRA‐CS) was an independent factor for MACEs (adjusted hazard ratio 1.099), providing incremental prognostic value (NRI 0.180, P = 0.10). Patients with worse IRA‐CS (>−8.64%) demonstrated a heightened susceptibility to MACE. Additionally, IRA‐CS was significantly associated with microvascular obstruction (MVO) (adjusted odds ratio 1.084) and infarct size (r = 0.395). IRA‐CS showed comparable prognostic effectiveness to global peak circumferential strain (NRI 0.100, P = 0.39), also counterbalancing contrast and non‐contrast risk models (NRI 0.205, P = 0.05). In Cohort 2, IRA‐CS demonstrated stability between two time points (P = 0.10). Based on risk models incorporating IRA‐CS, algorithm “HJKL” was preliminarily proposed for stratification.
Data Conclusions
IRA‐CS is an important prognostic factor, and an algorithm based on it is proposed for stratification.
Level of Evidence
4
Technical Efficacy
Stage 2