Determination of hemodynamic forces by Cardiac Magnetic Resonance as a marker of cardiovascular events

Abstract

Introduction: the assessment of ventricular hemodynamic forces (HDF) by cardiac magnetic resonance (CMR), derived from Global Longitudinal Strain, is an emerging technique for structural cardiac evaluation currently under investigation. This method may allow earlier detection of structural cardiac abnormalities and prediction of cardiovascular events. Objective: to assess hemodynamic forces in a population of patients undergoing CMR to determine their potential as markers of cardiovascular events. Materials and Methods: the authors conducted a retrospective analysis of 137 patients who underwent CMR with HDF assessment and clinical follow-up between 2015 and 2023. The primary endpoint was a composite of acute myocardial infarction, hospitalization for heart failure, and cardiac death. The authors analyzed apex–base and lateral–septal HDF, using cut-off values that maximized the risk of the composite endpoint.A multivariate survival analysis using the Cox proportional hazards regression model was performed to evaluate the hazard ratio (HR) of HDF. Results: a total of 126 patients completed the CMR evaluation and were included in the HDF analysis. Apex–base HDF with a cut-off value of 7.5% identified which patients would develop the composite event, while other predictors were not significant. The area under the ROC curve was 0.829 (95% CI 0.725–0.934), p < 0.0001.The presence of apex–base HDF < 7.5% showed an adjusted hazard ratio (HR) of 4.90 (1.63–14.68, p = 0.005),whereas the other CMR-derived predictors were not significant. Conclusions: the presence of apex–base HDF below 7.5% was significantly associated with a higher incidence of the composite endpoint compared with patients with HDF values above 7.5%.