Prognostic Significance of Feature-Tracking Right Ventricular Global Longitudinal Strain in Non-ischemic Dilated Cardiomyopathy

• Published in: Frontiers in cardiovascular medicine 2021-11, Vol.8, p.765274-765274
• Main Authors: Cittar, Marco, Cipriani, Alberto, Merlo, Marco, Vitrella, Giancarlo, Masè, Marco, Carrer, Anna, Barbati, Giulia, Belgrano, Manuel, Pagnan, Lorenzo, De Lazzari, Manuel, Giorgi, Benedetta, Cova, Maria A, Iliceto, Sabino, Basso, Cristina, Stolfo, Davide, Sinagra, Gianfranco, Perazzolo Marra, Martina
• Format: Article
• Language: English
• Subjects: cardiac magnetic resonance feature-tracking analysis; Cardiovascular Medicine; heart failure; non-ischemic cardiomyopathy; prognosis; right ventricle global longitudinal strain
• ISSN: 2297-055X; 2297-055X
• DOI: 10.3389/fcvm.2021.765274

Left ventricular global longitudinal strain (GLS) by cardiac magnetic resonance feature tracking (CMR-FT) analysis has shown an incremental prognostic value compared to classical parameters in non-ischemic dilated cardiomyopathy (NICM). However, less is known about the role of right ventricular (RV) GLS. Our objective was to evaluate the prognostic impact of RV-GLS by CMR-FT analysis in a population of NICM patients. In this multicenter study, we examined NICM patients evaluated with a comprehensive CMR-FT study. Major cardiac events (MACEs) were considered as the study primary outcome measure and were defined as a composite of (a) cardiovascular death, (b) cardiac transplant or destination therapy ventricular assist device, (c) hospitalization for life-threatening ventricular arrhythmias or implantable cardiac defibrillator appropriate intervention. Heart failure (HF) related events, including hospitalizations and life-threatening arrhythmia-related events were considered as secondary end-points. Receiver operating time-dependent analysis were used to calculate the possible additional effect of RV-GLS to standard evaluation. We consecutively enrolled 273 patients. During a median follow-up of 39 months, 41 patients (15%) experienced MACEs. RV-GLS and LV late gadolinium emerged as the strongest prognostic CMR-FT variables: their association provided an estimated 3-year MACEs rate of 29%. The addition of RV-GLS significantly improved the prognostic accuracy in predicting MACEs with respect to the standard evaluation including LGE (areas under the curve from 0.71 [0.66-0.82] to 0.76 [0.66-0.86], = 0.03). On competing risk analysis, RV-GLS showed a significant ability to reclassify overall both HF-related and life-threatening arrhythmia-related events, regardless of LV and RV ejection fraction. In NICM patients, RV-GLS showed a significant prognostic role in reclassifying the risk of MACEs, incremental with respect to standard evaluation with standard prognostic parameters.