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

Marco Cittar; Alberto Cipriani; Marco Merlo; Giancarlo Vitrella; Marco Masè; Anna Carrer; Giulia Barbati; Manuel Belgrano; Lorenzo Pagnan; Manuel De Lazzari; Benedetta Giorgi; Maria A Cova; Sabino Iliceto; Cristina Basso; Davide Stolfo; Gianfranco Sinagra; Martina Perazzolo Marra

doi:10.3389/fcvm.2021.765274

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

Front Cardiovasc Med. 2021 Nov 30:8:765274. doi: 10.3389/fcvm.2021.765274. eCollection 2021.

Authors

Marco Cittar¹, Alberto Cipriani², Marco Merlo¹, Giancarlo Vitrella¹, Marco Masè¹, Anna Carrer², Giulia Barbati³, Manuel Belgrano⁴, Lorenzo Pagnan⁴, Manuel De Lazzari², Benedetta Giorgi⁵, Maria A Cova⁴, Sabino Iliceto², Cristina Basso², Davide Stolfo¹, Gianfranco Sinagra¹, Martina Perazzolo Marra²

Affiliations

¹ Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, University of Trieste, Trieste, Italy.
² Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy.
³ Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy.
⁴ Department of Radiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, University of Trieste, Trieste, Italy.
⁵ Department of Radiology, Azienda Ospedaliera of Padua, University of Padua, Padua, Italy.

Abstract

Aims: 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. Methods: 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. Results: 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], p = 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. Conclusions: 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.

Keywords: cardiac magnetic resonance feature-tracking analysis; heart failure; non-ischemic cardiomyopathy; prognosis; right ventricle global longitudinal strain.