Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the sam
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RESEARCH
Layer‑specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the same Lingyu Xu1,2, Joseph J. Pagano1, Mark J. Haykowksy3, Justin A. Ezekowitz2,4, Gavin Y. Oudit2, Yoko Mikami5,6, Andrew Howarth5,6, James A. White5,6, Jason R. B. Dyck7, Todd Anderson8, D. Ian Paterson2, Richard B. Thompson1* and for the AB HEART Investigators
Abstract Background: Global longitudinal strain (GLS), most commonly measured at the endocardium, has been shown to be superior to left ventricular (LV) ejection fraction (LVEF) for the identification of systolic dysfunction and prediction of outcomes in heart failure (HF). We hypothesized that strains measured at different myocardial layers (endocardium = ENDO, epicardium = EPI, average = AVE) will have distinct diagnostic and predictive performance for patients with HF. Methods: Layer-specific GLS, layer-specific global circumferential strain (GCS) and global radial strain (GRS) were evaluated by cardiovascular magnetic resonance imaging (CMR) feature tracking in the Alberta HEART study. A total of 453 subjects consisted of healthy controls (controls, n = 77), at-risk for HF (at-risk, n = 143), HF with preserved ejection fraction (HFpEF, n = 87), HF with mid-range ejection fraction (HFmrEF, n = 88) and HF with reduced ejection fraction (HFrEF, n = 58). For outcomes analysis, CMR-derived imaging parameters were adjusted with a base model that included age and N-terminal prohormone of b-type natriuretic peptide (NT-proBNP) to test their independent association with 5-year all-cause mortality. Results: GLS_EPI distinguished all groups with preserved LVEF (controls − 16.5 ± 2.4% vs. at-risk − 15.5 ± 2.7% vs. HFpEF − 14.1 ± 3.0%, p
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