CAD: Chronic Coronary Syndromes
Theo Pezel, MD
Head of the Cardiovascular Imaging department
Lariboisiere University Hospital, APHP, Paris, France
Paris, Ile-de-France, France
Theo Pezel, MD
Head of the Cardiovascular Imaging department
Lariboisiere University Hospital, APHP, Paris, France
Paris, Ile-de-France, France
Solenn Toupin, PhD
Clinical scientist
Siemens Healthcare France, Scientific partnerships, Saint-Denis
Bordeaux, Aquitaine, France
Philippe Garot, MD
Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
Stéphane Champagne, MD
Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
Thomas Hovasse, MD
Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
Thierry Unterseeh, MD
Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
Teodora Chitiboi, PhD
Research Scientist
Siemens Healthcare GmbH, Hamburg, Germany
Hamburg, Germany
Puneet Sharma, PhD
Research & Technology Manager
Siemens Medical Solutions USA, Inc., Princeton, NJ, United States
Princeton, New Jersey, United States
Francesca Sanguineti, MD
Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
Jerome Garot, PhD
Head
ICPS - Massy
Massy, Ile-de-France, France
Recent studies emphasized that stress global circumferential strain (GCS) had incremental prognostic value beyond stress cardiovascular magnetic resonance (CMR) findings in patients with normal CMR defined by the absence of ischemia and late gadolinium enhancement. However, the prognostic value of regional strain measured at stress is not established.
We aimed to determine whether fully automated regional circumferential strain score (RSS) measured during vasodilator stress can provide incremental prognostic value to predict major adverse clinical events (MACE).
Methods:
From January to July 2017, we conducted a single-center study with all consecutive patients with normal stress CMR. Stress-RSS was assessed using a fully automatic machine-learning algorithm featured-tracking imaging-based for circumferential strain (Ecc) from short-axis cine images. Using −17% and −10% as Ecc cut-offs, each segment was rated from 0 to 2 points according to the Ecc value of each layer. The epi-Ecc values from the 16-segment model were used to calculate the stress-RSS, which was defined as a percentage of good LV regional function. The primary outcome was the occurrence of MACE defined as cardiovascular mortality or nonfatal myocardial infarction. Cox regressions were used to evaluate the association of RSS with the primary outcome after adjustment for traditional risk factors.
Results:
In 1,321 patients with normal CMR (65±12 years, 67% men), stress-RSS was inversely associated with MACE (median follow-up 5.1 [4.8-5.4] years) before and after adjustment for risk factors (adjusted hazard ratio [HR], 0.75; 95% CI: 0.70-0.80, p< 0.001). A stress-RSS value < 50% showed the best improvement in model discrimination and reclassification to predict MACE above traditional risk factors and stress CMR findings (C-statistic improvement: 0.29; NRI=0.569; IDI=0.153, Chi-2 global=125, all p< 0.001; LR-test p< 0.001).
Conclusion:
Layer-specific regional Ecc measured during stress CMR, defined by stress-RSS, provides a robust, independent and incremental predictive value for MACE over traditional risk factors and stress CMR findings in patients with normal CMR.