Layer-specific regional circumferential strain as prognostic marker of cardiovascular events

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Left ventricular (LV) circumferential strain (Ecc) is an accurate indicator of regional myocardial function. Recent studies have emphasized the potential superiority of regional Ecc, particularly using the layer-specific strain. To date, no studies have assessed the prognostic value of layer-specific regional Ecc in the general population. PURPOSE This study aimed to investigate the prognostic value of the layer-specific regional Ecc for predicting the incident of heart failure (HF) and coronary heart disease (CHD) in a population without a history of cardiovascular disease at baseline. METHODS Data from participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent tagged magnetic resonance imaging for strain determination were analyzed. Using −17% and −10% as Ecc cut-offs, each segment was rated from 0–2 points according to the Ecc value of each layer. The endo-Ecc, mid-Ecc, and epi-Ecc values from the 16-segment model were used to calculate three indexes: Endo-MyoHealth, Mid-MyoHealth, and Epi-MyoHealth, respectively, which were defined as a percentage of good LV regional function. The Intramyocardial-MyoHealth index was the sum of these three MyoHealth indexes. Cox proportional hazard models were used to evaluate the association between each MyoHealth index and incident HF and hard CHD. RESULTS Among the 1,506 participants (63.3 ± 9.4 years, 54.6% men), 122 cases of hard CHD and 91 cases of HF were observed (median [IQR] follow-up 15.9 [12.9-16.6] years). After adjustment, Mid-, Epi-, and Intramyocardial-MyoHealth index values <50% were independently associated with HF (adjusted HR 1.43; 95% CI [1.08-2.87], p = 0.004; HR 1.80; 95% CI [1.12-3.07], p < 0.001; and HR 2.01; 95% CI [1.19-3.20], p < 0.001). After adjustment, Endo-, Mid-, Epi-, and Intramyocardial-MyoHealth <50% were also independently associated with hard CHD (adjusted HR 1.31; 95% CI [1.03-1.51], p = 0.04; HR 1.79; 95% CI [1.26-2.57], p < 0.001; HR 2.03; 95% CI [1.45-3.40], p < 0.001; and HR 2.28; 95% CI [1.51-3.53], p < 0.001). CONCLUSIONS Layer-specific regional Ecc, assessed via MyoHealth indexes, provides a robust, independent predictive value for incident HF and hard CHD in asymptomatic participants without any history of previous clinical cardiovascular disease. Unique identifier Clinical.gov : NCT00005487. Abstract Figure.  Abstract Figure. Kaplan Meier curves