Assessment of the Prognostic Value of MRI Left Ventricular Global Function Index (LVGFI) in Patients With End-Stage Renal Disease Under Maintenance Dialysis

BACKGROUND

Left ventricular global function index (LVGFI) integrates LV volumetric and functional parameters. In patients with end-stage renal disease (ESRD), cardiac injury manifests as LV hypertrophy and dysfunction. However, the prognostic value of LVGFI in this population remains unclear.

PURPOSE

To investigate the association of LVGFI with major adverse cardiac events (MACE) in patients with ESRD.

STUDY TYPE

Prospective.

POPULATION

One hundred fifty-eight ESRD patients (mean age: 54.1 ± 14.4 years; 105 male) on maintenance dialysis.

FILED STRENGTH/SEQUENCE

3.0 T, balanced steady-state free precession (bSSFP) cine and modified Look-Locker inversion recovery (MOLLI) sequences.

ASSESSMENT

LV volumetric and functional parameters were determined from bSSFP images. LVGFI was calculated as the ratio of stroke volume to global volume and native T1 was determined from MOLLI T1 maps. MACE was recorded on follow up. Models were developed to predict MACE from conventional risk factors combined with LVGFI, GLS, native T1, and LV mass index (LVMI), respectively. Subgroup analyses were further performed in participants with LVEF above median.

STATISTICAL TESTS

Cox proportional hazard regression and log-rank test were used to investigate the association between LVGFI and MACE. The predictive models were evaluated and compared using Harrell's C-statistics and DeLong tests. A P value <0.05 was considered statistically significant.

RESULTS

Thirty-four MACE occurred during the median follow-up period of 26 months. The hazard of MACE increased by 114% for each 10% decrease in LVGFI in univariable analysis. The predictive model consisting of LVGFI (C-statistic: 0.724) had significantly better predictive performance than the others (all P < 0.001). These results were consistent in patients (N = 79) with LVEF > median (63.54%).

DATA CONCLUSION

LVGFI is a novel marker for MACE risk stratification in patients with ESRD and was better able to predict MACE than native T1 mapping and GLS.

EVIDENCE LEVEL

2 TECHNICAL EFFICACY: Stage 3.

Prognostic value of cardiac magnetic resonance parameters and biomarkers following myocardial infarction; 10 year follow-up of the Eplerenone Remodeling in Myocardial Infarction without Heart Failure trial

INTRODUCTION

Prediction of adverse outcome following myocardial infarction (MI) remains challenging. We reviewed baseline biomarker and cardiac magnetic resonance (CMR) data to identify predictors of outcome in a cohort of patients enrolled in a clinical trial assessing the effect of eplerenone on left ventricular (LV) remodeling after MI, followed for over 10 years.

METHODS AND RESULTS

100 patients (mean age 59yr, 77% male) admitted with MI between 2004-06, LV ejection fraction (LVEF) <40% but no heart failure had a baseline CMR and measurement of N-terminal pro-B-type natriuretic peptide [NT-proBNP], galectin-3 and ST2 prior to 1:1 randomization to placebo:eplerenone, given for 24 weeks. All-cause mortality and the composite of death, nonfatal MI and heart failure hospitalization were recorded over median 9.3 years. 16 (16.0%) patients died during follow-up and 25 (25.0%) suffered the composite outcome. LV volumes, anterior infarct location, infarct subendocardial extent and degree of LV remodeling were higher in those who died but LVEF was similar. Higher concentrations of NT-proBNP (5074 [1238] vs. 2101 [176]ng/L, p<0.001) and galectin-3 (18.0 [2.1] vs. 14.0 [0.5]ng/mL, p=0.007) were seen in non-survivors. Lower left ventricular global function index (LVGFI) was associated with higher NT-proBNP and ST2 levels (p<0.01). Baseline LV end-systolic volume index (LVESVI), end-diastolic volume index (LVEDVI), NT-proBNP, and galectin-3 were univariate predictors of death; LVESVI and NT-proBNP remained significant on multivariate analysis.

CONCLUSIONS

CMR-derived LV volumes and baseline biomarkers provide additional prognostic information in survivors of MI. LVGFI has potential in identifying patients at high risk of adverse remodeling. This article is protected by copyright. All rights reserved.

Association Between Left Ventricular Global Function Index and Outcomes in Patients With Dilated Cardiomyopathy

Purpose: Left ventricular global function index (LVGFI) assessed using cardiac magnetic resonance (CMR) seems promising in the prediction of clinical outcomes. However, the role of the LVGFI is uncertain in patients with heart failure (HF) with dilated cardiomyopathy (DCM). To describe the association of LVGFI and outcomes in patients with DCM, it was hypothesized that LVGFI is associated with decreased major adverse cardiac events (MACEs) in patients with DCM. Materials and Methods: This prospective cohort study was conducted from January 2015 to April 2020 in consecutive patients with DCM who underwent CMR. The association between outcomes and LVGFI was assessed using a multivariable model adjusted with confounders. LVGFI was the primary exposure variable. The long-term outcome was a composite endpoint, including death or heart transplantation. Results: A total of 334 patients (mean age: 55 years) were included in this study. The average of CMR-LVGFI was 16.53%. Over a median follow-up of 565 days, 43 patients reached the composite endpoint. Kaplan-Meier analysis revealed that patients with LVGFI lower than the cutoff values (15.73%) had a higher estimated cumulative incidence of the endpoint compared to those with LVGFI higher than the cutoff values (P = 0.0021). The hazard of MACEs decreased by 38% for each 1 SD increase in LVGFI (hazard ratio 0.62[95%CI 0.43-0.91]) and after adjustment by 46% (HR 0.54 [95%CI 0.32-0.89]). The association was consistent across subgroup analyses. Conclusion: In this study, an increase in CMR-LVGFI was associated with decreasing the long-term risk of MACEs with DCM after adjustment for traditional confounders.

Left ventricular global function index assessed by cardiovascular magnetic resonance for the prediction of cardiovascular events in ST-elevation myocardial infarction

BACKGROUND

The left ventricular performance index (LVGFI) as a comprehensive marker of cardiac performance integrates LV structure with global function within one index. In a prospective cohort study of healthy individuals the LVGFI demonstrated a superior prognostic value as compared to LV ejection fraction (LVEF). In patients after ST-segment elevation myocardial infarction (STEMI), however, the role of the LVGFI is unknown. Aim of this study was to investigate the relationship between the LVGFI and infarct characteristics as well as prognosis in a large multicenter STEMI population.

METHODS

In total 795 STEMI patients reperfused by primary angioplasty (<12 h after symptom onset) underwent cardiovascular magnetic resonance (CMR) at 8 centers. CMR was completed within one week after infarction using a standardized protocol including LV dimensions, mass and function for calculation of the LVGFI. The primary clinical endpoint of the study was the occurrence of major adverse cardiac events (MACE).

RESULTS

The median LVGFI was 31.2 % (interquartile range 25.7 to 36.6). Patients with LVGFI < median had significantly larger infarcts, less myocardial salvage, a larger extent of microvascular obstruction, higher incidence of intramyocardial hemorrhage and more pronounced LV dysfunction (p < 0.001 for all). MACE and mortality rates were significantly higher in the LVGFI < median group (p < 0.001 and p = 0.003, respectively). The LVGFI had an incremental prognostic value in addition to LVEF for prediction of all-cause mortality.

CONCLUSIONS

The LVGFI strongly correlates with markers of severe myocardial and microvascular damage in patients with STEMI, offering prognostic information beyond traditional cardiac risk factors including the LVEF.

TRIALS REGISTRATION

ClinicalTrials.gov: NCT00712101.