CMR-derived atrial strain in the prediction of adverse cerebrovascular events after myocardial infarction

This study investigated whether cardiovascular magnetic resonance (CMR)-derived atrial strain parameters are associated with new-onset cerebrovascular events in patients with reperfused ST-segment elevation myocardial infarction (STEMI). In this retrospective analysis, CMR scans of 211 consecutive STEMI patients (77% male; mean age 64.5 ± 10.3 years) who underwent coronary revascularization were assessed. The primary endpoint was the occurrence of acute ischemic stroke or transient ischemic attack, collectively defined as cerebrovascular events. Atrial strain was analyzed offline from standard cine steady-state free precession sequences, focusing on left atrial (LA) reservoir, conduit, and booster strain. Over a median follow-up of 25 months (interquartile range 13-36), 23 patients (11%) experienced cerebrovascular events. In multivariable Cox regression analysis, LA reservoir and conduit strain were independent predictors of these events, irrespective of cardiovascular risk factors, LA volume, thrombus presence, and incident atrial fibrillation (HR: 0.84; 95% CI: 0.77-0.91; p = 0.001 and HR: 0.74; 95% CI: 0.63-0.87; p = 0.001, respectively). In conclusion, CMR-derived LA reservoir and conduit strain are independently associated with increased risk of cerebrovascular events, and their integration into the clinical assessment of STEMI patients may improve risk stratification.