title: Reduced long axis strain is associated with heart failure and cardiovascular events in the multi-ethnic study of Atherosclerosis.
abstract: To propose long axis strain (LAS), a novel index of global left ventricle (LV) function, as a sensitive and powerful predictor of hard cardiovascular events and heart failure in the Multi-Ethnic Study of Atherosclerosis (MESA).
  
  
  
  Strain is an index of relative myocardial deformation, and enables normalization for differences in heart size. Measurement of strain conventionally requires dedicated software and protocols for image acquisition. LAS, however, can be analyzed using a caliper tool from conventional LV long axis magnetic resonance imaging (MRI) cine loops, reflecting the average myocardial contraction in the longitudinal direction. In all, 1651 participants (53% men) of the MESA study, without a history of myocardial infarction or heart failure, were assessed using conventional cine MR images. LV lengths were assessed at end-diastole (EDL ) and end-systole (ESL ), and LAS was calculated as 100*(EDL -ESL )/EDL . Participants were followed for 6.8 ± 1.8 years for a composite endpoint of congestive heart failure or hard cardiovascular events, and the predictive ability of LAS was tested, unadjusted and adjusted for established cardiovascular risk factors.
  
  
  
  A total of 114 events were observed. Mean LAS was 11.7 ± 2.5% and 10.0 ± 2.7% in participants without and with events, respectively (P < 0.001). Increased LAS reduced the hazard ratio to 0.75 for univariate, and 0.88 for multivariate assessments, respectively (both P < 0.001).
  
  
  
  Assessment of long axis LV deformation by LAS is feasible and reproducible. Moreover, LAS predicts hard cardiovascular events and congestive heart failure in a multi-ethnic population without overt cardiovascular disease at inclusion. J. Magn. Reson. Imaging 2016;44:178-185.
authors.affiliation: Johns Hopkins University, Department of Cardiology, Baltimore, Maryland, USA.|Oslo University Hospital, Department of Cardiology, Oslo, Norway.
authors.forename: Ola
authors.initials: O
authors.lastname: Gjesdal
authors.affiliation: Johns Hopkins University, Department of Cardiology, Baltimore, Maryland, USA.
authors.forename: Kihei
authors.initials: K
authors.lastname: Yoneyama
authors.affiliation: Johns Hopkins University, Department of Cardiology, Baltimore, Maryland, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Mewton
authors.affiliation: National Heart, Lung and Blood Institute, Office of Biostatistics Research, Bethesda, Maryland, USA.
authors.forename: Colin
authors.initials: C
authors.lastname: Wu
authors.affiliation: UCLA School of Medicine, Department of Radiology, Los Angeles, California, USA.
authors.forename: Antoinette S
authors.initials: AS
authors.lastname: Gomes
authors.affiliation: Wake Forest University Health Sciences, Department of Cardiology, Winston-Salem, North Carolina, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Hundley
authors.affiliation: Columbia University, Department of Radiology, New York, New York, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
authors.affiliation: Columbia University, Departments of Medicine and Epidemiology, New York, New York, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.affiliation: Northwestern University Medical School, Department of Preventive Medicine, Chicago, Illinois, USA.
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: Johns Hopkins University, Department of Cardiology, Baltimore, Maryland, USA.
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
mesh_terms: D000368:Aged; D015897:Comorbidity; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000503:physiopathology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D015995:Prevalence; D044469:Racial Groups / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000503:physiopathology*
keywords: long axis strain; multi-ethnic study; myocardial dysfunction