Work

CMR-Derived Global Longitudinal Strain and Left Ventricular Torsion as Prognostic Markers in Dilated Cardiomyopathy

Year: 2025

Type: article

Abstract: Background: Non-ischemic dilated cardiomyopathy (DCM) is a heterogeneous myocardial disease associated with variable progression and an increased risk of major adverse cardiovascular events (MACEs). Cardiovascular magnetic resonance (CMR) allows the comprehensive evaluation of myocardial structure, function, and fibrosis. This prospective study aimed to assess the prognostic value of CMR-derived global longitudinal strain (GLS) and left ventricular (LV) torsion in patients with DCM. Methods: We prospectively enrolled 150 patients with newly diagnosed non-ischemic DCM and 100 age- and sex-matched healthy controls. All participants underwent standardized CMR protocols including cine imaging, late gadolinium enhancement (LGE), and feature-tracking analysis for myocardial deformation. LV volumes, ejection fraction (LVEF), GLS, and LV torsion were quantified. The primary endpoint was the first occurrence of MACE, defined as cardiac death, sustained ventricular arrhythmia, or heart failure hospitalization. The median follow-up was 33 months. Results: Compared to controls, DCM patients had significantly impaired LV function and myocardial mechanics: lower LVEF (35.1% vs. 65.2%, p < 0.001), reduced GLS (−9.2% vs. −19.7%, p < 0.001), and diminished LV torsion (1.04 vs. 1.95 °/cm, p < 0.001). GLS ≤ −8.6% was independently associated with increased MACE risk (adjusted hazard ratio [HR]: 1.09; 95% confidence interval [CI]: 1.01–1.61; p < 0.01). Similarly, reduced LV torsion predicted adverse events (adjusted HR: 1.37; 95% CI: 1.03–1.81; p < 0.01). The presence of LGE (42% of patients) further stratified risk (HR: 2.86; 95% CI: 1.48–12.52; p < 0.001). Conclusions: CMR-derived GLS and LV torsion are strong, independent predictors of adverse outcomes in DCM. Their integration into routine imaging protocols enhances risk stratification beyond conventional metrics such as LVEF and LGE. These findings support the use of myocardial deformation analysis in the comprehensive evaluation of patients with DCM.

Source: Journal of Cardiovascular Development and Disease

DOI: 10.3390/jcdd12090340

Authors: Alexandru Zlibut, Michael Bietenbeck, Lucia Agoston-Coldea

Institutions: Iuliu Hațieganu University of Medicine and Pharmacy, University Hospital Münster, Affidea, Spitalul Clinic Județean de Urgență Cluj-Napoca

Language: English

Topic: Cardiovascular Function and Risk Factors

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,258