Left atrial mechanics in patients with acute STEMI and secondary mitral regurgitation: A prospective pilot CMR feature tracking study

Tomas Lapinskas; Paulius Bučius; Laura Urbonaitė; Agnieta Stabinskaitė; Živilė Valuckienė; Lina Jankauskaitė; Rimantas Benetis; Remigijus Žaliūnas

doi:10.1016/j.medici.2017.02.001

Left atrial mechanics in patients with acute STEMI and secondary mitral regurgitation: A prospective pilot CMR feature tracking study

Medicina (Kaunas). 2017;53(1):11-18. doi: 10.1016/j.medici.2017.02.001. Epub 2017 Mar 1.

Authors

Tomas Lapinskas¹, Paulius Bučius², Laura Urbonaitė², Agnieta Stabinskaitė², Živilė Valuckienė², Lina Jankauskaitė³, Rimantas Benetis⁴, Remigijus Žaliūnas²

Affiliations

¹ Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address: tomas.lapinskas@lsmuni.lt.
² Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
³ Department of Internal Medicine II, University Clinic Giessen-Marburg, Giessen, Germany.
⁴ Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.

PMID: 28283244
DOI: 10.1016/j.medici.2017.02.001

Abstract

Background and objective: Left atrium (LA) is an important biomarker of adverse cardiovascular outcomes and cerebrovascular events. This study aimed to evaluate LA myocardial deformation using cardiac magnetic resonance feature tracking (CMR-FT) in patients with acute ST-segment elevation myocardial infarction (STEMI) and secondary mitral regurgitation (MR). Additionally, to assess interobserver and intraobserver variability of the technique.

Materials and methods: Twenty patients with STEMI underwent CMR with a 1.5Tesla MRI scanner. According to the presence of MR patients were divided into two groups: MR(+) and MR(-). Total LA strain (ɛ_s), passive LA strain (ɛ_e), and active LA strain (ɛ_a) were obtained. Additionally, total, passive and active strain rates (SR_s, SR_e, and SR_a) were calculated. To assess interobserver agreement data analysis was performed by second independent observer.

Results: LA volumetric and functional parameters were similar in both groups. All LA strain values were significantly higher in patients with MR: ɛ_s (27.67±10.25 for MR(-) vs. 32.80±6.95 for MR(+); P=0.01), ɛ_e (15.29±7.30 for MR(-) vs. 19.22±6.04 for MR(+); P=0.01) and ɛ_a (12.38±4.23 for MR(-) vs. 14.44±5.19 for MR(+); P=0.03). Only SR_e significantly increased in patients with MR (-0.57±0.24 for MR(-) vs. -0.70±0.20 for MR(+); P=0.01). All LA deformation parameters demonstrated high interobserver and intraobserver agreement.

Conclusions: Conventional volumetric and functional LA parameters do not detect early changes in LA performance in patients with STEMI and secondary MR. In contrast, LA reservoir, passive and active strain are significantly higher in patients with MR. Only peak early negative strain rate substantially increases during secondary MR. LA deformation parameters derived from conventional cine images using CMR-FT technique are highly reproducible.

Keywords: Cardiac magnetic resonance; Feature tracking; Left atrium; Myocardial deformation; Reproducibility.

MeSH terms

Aged
Atrial Function, Left
Echocardiography
Female
Heart Atria / diagnostic imaging
Heart Atria / physiopathology
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Mitral Valve Insufficiency / diagnostic imaging*
Mitral Valve Insufficiency / physiopathology*
Observer Variation
Pilot Projects
Prospective Studies
Reproducibility of Results
ST Elevation Myocardial Infarction / diagnostic imaging*
ST Elevation Myocardial Infarction / physiopathology*
Statistics, Nonparametric
Stroke Volume