Incremental Prognostic Value of Left Atrial Strain in Patients With Suspected Myocarditis and Preserved Left Ventricular Ejection Fraction.

IF 3.3 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Journal of Magnetic Resonance Imaging Pub Date : 2025-02-01 Epub Date: 2024-05-09 DOI:10.1002/jmri.29429

Yan Chen, Nan Zhang, Wenjing Zhao, Zhonghua Sun, Jiayi Liu, Dongting Liu, Zhaoying Wen, Lei Xu

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Abstract

Background: Analysis of left atrial (LA) strain and left atrioventricular coupling index (LACI) have prognostic value in cardiovascular diseases. However, the prognostic value of LA strain and LACI in patients with suspected myocarditis and preserved left ventricular ejection fraction (LVEF) is unclear.

Purpose: To investigate the prognostic value of LA strain and LACI in patients with suspected myocarditis and preserved LVEF in comparison with conventional MRI outcome predictors.

Study type: Retrospective.

Population: One hundred sixty-five patients with clinically suspected myocarditis and preserved LVEF with available follow-up data.

Field strength/sequence: Steady-state free precession cine and phase-sensitive inversion recovery segmented gradient echo late gadolinium enhancement sequences at 3.0 T.

Assessment: Left ventricular (LV) and LA strain were evaluated using feature tracking. LACI was calculated as the ratio of LA and LV volumes at LV end-diastole. Patients were followed-up with the primary endpoint being major adverse cardiovascular events (MACE).

Statistical tests: Independent-samples t-test and Mann-Whitney U test to compare patients with and without MACE, receiver operating characteristic (ROC) curve analysis to define high/low risk groups, Kaplan-Meier survival analysis and Cox proportional hazards regression to assess prognosis. A P value of <0.05 was considered statistically significant.

Results: The associations of LV strain parameters (including global radial, circumferential, and longitudinal strain) and LACI with MACE were not significant (P = 0.511, 0.108, 0.148, and 0.847, respectively). An optimal LA conduit strain (Ԑe) cutoff value of 10.4% was identified to best classify patients into low- and high-risk groups. Only Ԑe was significantly associated with MACE in both univariable (hazards ratio [HR] 0.936, 95% confidence interval [CI] 0.884-0.991) and multivariable Cox survival analyses (HR 0.937, 95% CI 0.884-0.994).

Data conclusion: LA conduit strain has prognostic value in patients with suspected myocarditis and preserved LVEF, incremental to conventional MRI outcome predictors, whereas LACI was not associated with MACE occurrence.

Evidence level: 3 TECHNICAL EFFICACY: Stage 2.

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左心房应变对疑似心肌炎且左室射血分数保留患者的增量预后价值

背景：左心房（LA）应变和左房室耦合指数（LACI）分析对心血管疾病具有预后价值。目的：研究 LA 应变和 LACI 在疑似心肌炎且左室射血分数（LVEF）保留患者中的预后价值，并与常规 MRI 结果预测指标进行比较：研究类型：回顾性研究：165例临床疑似心肌炎且LVEF保留、有随访数据的患者：场强/序列：3.0 T 的稳态自由前驱 cine 和相敏反转恢复分段梯度回波晚期钆增强序列：采用特征追踪法评估左心室和 LA 应变。LACI以左心室舒张末期LA和LV容积之比计算。对患者进行随访，主要终点是主要不良心血管事件（MACE）：独立样本 t 检验和 Mann-Whitney U 检验比较有 MACE 和无 MACE 的患者，接收器操作特征（ROC）曲线分析界定高/低风险组，卡普兰-梅耶生存分析和 Cox 比例危险回归评估预后。结果的P值为0：左心室应变参数（包括整体径向应变、环向应变和纵向应变）和LACI与MACE的关系不显著（P分别为0.511、0.108、0.148和0.847）。最佳 LA 导管应变（Ԑe）临界值为 10.4%，可将患者分为低危和高危两组。在单变量分析（危险比 [HR] 0.936，95% 置信区间 [CI] 0.884-0.991）和多变量 Cox 生存分析（HR 0.937，95% CI 0.884-0.994）中，只有Ԑe 与 MACE 显著相关：数据结论：LA导管应变对疑似心肌炎且LVEF保留的患者具有预后价值，比常规MRI结果预测指标更重要，而LACI与MACE发生率无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Magnetic Resonance Imaging 医学-核医学

CiteScore

9.70

自引率

6.80%

发文量

494

审稿时长

2 months

期刊介绍： The Journal of Magnetic Resonance Imaging (JMRI) is an international journal devoted to the timely publication of basic and clinical research, educational and review articles, and other information related to the diagnostic applications of magnetic resonance.