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Clinical & Translation

Clinical & Translation 9: CMR Trials

Change in the Myocardial Strain-Based on Regional Strain Score: a Prognostic Marker of Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis (MESA)

Thursday, January 30, 2025
6:20 PM – 6:30 PM East Coast USA Time
Location: Regency Room
Background: We previously developed a strain indicator that identified regional as opposed to global myocardial dysfunction – the regional strain score (RSS) [1]. We showed that reduced RSS at baseline predicted incident heart failure (HF) and coronary heart disease (CHD). This investigation focuses on assessing the prognostic value of changes in RSS over 10 years to predict HF, stroke, and CHD in a population without a history of cardiovascular disease at baseline.

Methods: Participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent tagged CMR at the baseline (Year-0) and follow-up (Year-10) for left ventricular circumferential strain (Ecc) determination were included. Using -17% and -10% as Ecc cut-offs, each segment was rated from 0 to 2 points according to the Ecc value. 2: < -17%, 1:-10% to -17%, 0: >-10%. The endo-Ecc, mid-Ecc, and epi-Ecc values from the 16-segment model were used to calculate three RSS. The Intramyocardial-RSS (iRSS) was the sum of these three RSS expressed as a percentage. Cox proportional hazard models adjusted for cardiovascular risk factors (body mass index, hypertension, diabetes, smoking, hyperlipidemia) and demographics (age, gender, race) were used to evaluate the association between change in RSS (follow-up – baseline) and incident HF, stroke, and CHD. Participants who had either of the events in the interim period were excluded from this analysis.

Results: Among the 742 participants (63.3 ± 9.4 years, 54.6% men), 46 cases of CHD, 41 cases of stroke, and 29 cases of HF were observed [median (IQR) follow-up 8.5 (8-8.8) years]. The global Ecc was -15.4±2.8% at baseline and -16.7±3.1% at follow-up, and their difference was -1.2±3.9% (p < 0.05). The ejection fraction (EF) decreased by 0.62% (p=0.02) during the same period from the baseline (62.4±5.9%) to the follow-up (61.8±7.6%). iRSS at baseline was 63.6±14.3% and at follow-up was 70.5±17.1% and this increase was significant (p < 0.05). The change in global Ecc values over 10 years was not predictive of incident events. Change in EF was not associated with CHD, but was associated with stroke and HF univariably. After adjustment only the association with stroke (HR:0.96 [0.92-0.99]) persisted. The change in iRSS was associated with incident stroke and HF, but not CHD. When stratified based on the median change, those with an iRSS change lower than 7.2% had a higher likelihood of incident stroke HR:0.45 [CI: 0.23-0.86], than those with a change greater than 7.2% (Figure 1A). This association was significant even after adjustment HR:0.44 [CI: 0.23-0.88]. Similarly, those with a greater decrease in iRSS had higher risk of HF both in the univariable (HR: 0.45 [0.20-0.98]) and multivariable models (HR:0.43 [0.19-0.97]) (Figure 1B).

Conclusion:

Changes in layer-specific regional Ecc, assessed by iRSS, provides a robust, independent predictor for incident HF and stroke. iRSS may be a more sensitive marker of incident events as compared to global strain.

Kaplan–Meier survival curves for incident stroke (A), HF (B) and CHD (C) based on the change in iRSS ( <7.2% decrease) over 10 years.