title: Assessment of myocardial deformation with cardiac magnetic resonance strain imaging improves risk stratification in patients with dilated cardiomyopathy.
abstract: OBJECTIVE
  To investigate the prognostic impact of left-ventricular (LV) cardiac magnetic resonance (CMR) deformation imaging in patients with non-ischaemic dilated cardiomyopathy (DCM) compared with late-gadolinium enhancement (LGE) quantification and LV ejection fraction (EF).
  
  
  RESULTS
  A total of 210 subjects with DCM were examined prospectively with standard CMR including measurement of LGE for quantification of myocardial fibrosis and feature tracking strain imaging for assessment of LV deformation. The predefined primary endpoint, a combination of cardiac death, heart transplantation, and aborted sudden cardiac death, occurred in 26 subjects during the median follow-up period of 5.3 years. LV radial, circumferential, and longitudinal strains were significantly associated with outcome. Using separate multivariate analysis models, global longitudinal strain (average of peak negative strain values) and mean longitudinal strain (negative peak of the mean curve of all segments) were independent prognostic parameters surpassing the value of global and mean LV radial and circumferential strain, as well as NT-proBNP, EF, and LGE mass. A global longitudinal strain greater than -12.5% predicted outcome even in patients with EF < 35% (P < 0.01) and in those with presence of LGE (P < 0.001). Mean longitudinal strain was further investigated using a clinical model with predefined cut-offs (EF < 35%, presence of LGE, NYHA class, mean longitudinal strain greater than -10%). Mean longitudinal strain exhibited an independent prognostic value surpassing that provided by NYHA, EF, and LGE (HR = 5.4, P < 0.01).
  
  
  CONCLUSIONS
  LV longitudinal strain assessed with CMR is an independent predictor of survival in DCM and offers incremental information for risk stratification beyond clinical parameters, biomarker, and standard CMR.
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany.
authors.forename: Sebastian J
authors.initials: SJ
authors.lastname: Buss
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany.
authors.forename: Kristin
authors.initials: K
authors.lastname: Breuninger
authors.affiliation: Department of Radiology, Ev.-Luth. Diakonissenanstalt, Knuthstraße 1, Flensburg 24939, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lehrke
authors.affiliation: Department of Psychology, University of Heidelberg, Hauptstrasse 47-51, Heidelberg 69117, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Voss
authors.affiliation: TomTec Imaging Systems GmbH, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Galuschky
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Lossnitzer
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Andre
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Ehlermann
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Franke
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Taeger
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Frankenstein
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Steen
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Meder
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany gkorosoglou@hotmail.com.
authors.forename: Grigorios
authors.initials: G
authors.lastname: Korosoglou
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005682:Gadolinium; D006801:Humans; D007091:Image Processing, Computer-Assisted; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate
chemical_list: D005682:Gadolinium
keywords: Biomarker; Cardiac magnetic resonance; Dilated cardiomyopathy; Left ventricular function; Prognosis; Two-dimensional strain imaging