Cardiac Magnetic Resonance Strain for the Prediction of Cardiac Outcomes. Systematic Review and Meta-analysis Based on Individual Patient Data.

Abstract

Abstract BACKGROUND.Cardiac magnetic resonance (CMR) is the gold standard for the diagnostic classification and risk stratification in most patients with cardiac disorders. PURPOSE/HYPOTHESIS.To investigate the ability of Strain-encoded MR (SENC) for the prediction of major adverse cardiovascular events (MACE). STUDY TYPE Systematic review and meta-analysis according to the PRISMA Guidelines. POPULATION.Patients with or without cardiovascular disease and asymptomatic individuals. FIELD STRENGTH/SEQUENCE Myocardial strain by HARP in 1.5T scanners. ASSESSMENT.Published literature in MEDLINE (PubMed) and Cochrane’s databases were explored before February 2023 for studies assessing the clinical utility of myocardial strain by Harmonic Phase Magnetic Resonance Imaging (HARP), Strain-encoded MR (SENC) or fast-SENC. In total, 8 clinical trials (4 studies conducted in asymptomatic individuals and 4 in patients with suspected or known cardiac disease) were included in this systematic review, while 3 studies were used for our meta-analysis, based on individual patient level data. STATISTICAL TESTS. Kaplan-Meier analysis and Cox proportional hazard models were used, testing the ability of myocardial strain by HARP and SENC/fast-SENC for the prediction of MACE. RESULTS Strain enabled risk stratification in asymptomatic individuals, predicting MACE and the development of incident heart failure. Of 1,332 patients who underwent clinically indicated CMR, including SENC or fast-SENC acquisitions, 19 patients died, 28 experienced non-fatal infarctions, 52 underwent coronary revascularization and 86 were hospitalized due to heart failure during 22.4(17.2-28.5) months of follow-up. SENC/fast-SENC, predicted both all-cause mortality and MACE with high accuracy (HR=3.0, (95%CI=1.2-7.6), p=0.02 and HR=4.1, 95%CI=3.0-5.5, respectively, p<0.001). Using hierarchical cox-proportional hazard regression models, SENC/fast-SENC exhibited incremental value to clinical data and conventional CMR markers. DATA CONCLUSION. Reduced myocardial strain predicts of all-cause mortality and cardiac outcomes in symptomatic patients with a wide range of ischemic or non-ischemic cardiac diseases, whereas in asymptomatic individuals, reduced strain is a precursor of incident heart failure.