P5288Slice position vulnerability in the basal and apical parts for right ventricular circumferential strain measurement with feature tracking cardiac magnetic resonance

Abstract Background Strain is a more sensitive and precise parameter than ejection fraction (EF) for detection and characterization of subclinical left ventricular (LV) dysfunction and remodeling. Similar relationship is expected for right ventricle (RV); however RV functional parameters are less validated. Feature tracking strain analysis based on standard cardiac magnetic resonance (CMR) cine imaging is available for both ventricles. We experience a large slice-to-slice variation for RV global circumferential strain (GCS), possibly making the parameter vulnerable to minute position changes. Purpose To evaluate slice-to-slice differences in RV GCS for identification of the least variation region in a patient group without regional RV disease, in order to achieve a robust method for measurement. Hypothesis The slice-to-slice difference in peak GCS is lower in the mid-ventricular part of the RV than in the basal and apical parts. Methods 50 patients 6–72 months after pulmonary embolism without other major cardiopulmonary disease were included; mean age 60 years (range: 18–75 years); 68% men. Standard 2D cine CMR was obtained in longitudinal planes and in 10–12 consecutive 10 mm short axis planes for complete coverage of the RV. RV free wall and the inner contour of the septum were manually segmented on every end-diastolic and end-systolic slice from the pulmonary valve to the apex for feature tracking strain analysis. Peak RV GCS for every short axis slice and GCS difference (absolute percentage points) between adjacent slices were calculated. RV EF and peak RV GLS from the 4-chamber image were measured for correlation to RV GCS. Wilcoxon signed rank test and Pearson correlation were performed. Confidence intervals of means are based on 1000 bootstrap samples. Results RV EF was 46.6% (95% CI: 44.3; 48.8), RV peak GLS was −17.6% (95% CI: −18.6; −16.6). RV mid-ventricular GCS was −10.9% (95% CI: −12.0; −9.9). RV peak GCS slice-to-slice difference was 6.8 absolute percentage points (95% CI: 6.0; 7.6) in the basal part, 2.7 (95% CI: 2.4; 3.0) in the mid-ventricular part and 4.6 (95% CI: 3.9; 5.3) apically. Difference was significantly lower in mid-ventricular (p<0.001) compared to both basal and apical. RV EF correlated to RV peak GLS (r: −0.397, p=0.004) and mid-ventricular peak GCS (r: −0.356, p=0.01) but not to basal or apical peak GCS. RV peak GLS correlated to basal and mid-ventricular peak GCS (r: 0.313, p=0.03 and r: 0.301, p=0.03 respectively) but not to apical peak GCS. Figure 1 shows slice-to-slice difference (expressed in absolute percentage points) in right ventricular peak GCS. Conclusion Slice-to-slice difference in RV peak GCS was significantly lower in the mid-ventricular region. Large differences in the basal and apical parts indicate that measurements largely depend on slice positioning.

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P5253Does regional myocardial strain by cardiac magnetic resonance feature tracking reflect scar in ischemic heart disease?

European Heart Journal ◽

10.1093/eurheartj/ehz746.0224 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Stathogiannis ◽

V Mor-Avi ◽

R Lang ◽

A R Patel

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Feature Tracking ◽

Circumferential Strain ◽

Myocardial Strain ◽

Strain Analysis ◽

Left Ventricular ◽

Lv Function ◽

Regional Strain ◽

The Relationship

Abstract Background Cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) is the gold standard for detection of myocardial scar. We hypothesized that CMR Feature Tracking (FT)-derived regional myocardial strain may reflect the presence of scar and could thus potentially be used instead of LGE imaging. Purpose The aim of this study was to determine the relationship between FT-derived regional myocardial strain and LGE in patients with coronary artery disease (CAD). Methods Seventy-five patients with CAD and typical ischemic LGE patterns on CMR (1.5T) were included (mean age 60±12 years, 70% males). Myocardial strain analysis and LGE identification were performed using dedicated commercial software. Scar was defined by presence of LGE in the same area of the myocardium in both short- and long-axis views. Peak systolic regional longitudinal and circumferential strain (RLS, RCS) values were calculated in the region of interest corresponding to the LGE area and also in a non-LGE myocardial region as a reference in each patient. These comparisons were repeated for a subgroup of 36 patients with left ventricular (LV) ejection fraction (EF) <40% to determine whether the relationship between strain and LGE holds in the presence of reduced LV function, when strain measurements may be altered as a reflection of reduced LVEF itself. Results Both global longitudinal and circumferential strain values were abnormal (−12.8±5.1% and −11.4±4.1%, respectively), reflecting LV dysfunction in this CAD cohort (EF = 40±16%). The magnitude of both RLS and RCS was significantly reduced in areas of LGE, compared to those without LGE: RLS −10.0±5.8% versus −20.4±7.5% (p<0.001); RCS −10.1±5.3±% versus −18.9±7.5%, respectively (p<0.001). Same pattern was noted in the reduced EF subgroup: RLS −8.0±4.7% versus −16.9±6.6% (p<0.001), RCS −7.7±4.3±% versus −16.0±7.9%, respectively (p<0.001). The figure depicts 2 representative cases in long and short axis views, LGE detection and concomitant regional strain analysis. LGE and regional strain analysis. Conclusion Reduced magnitude of regional longitudinal and circumferential strain by CMR-FT correlates with presence of LGE. Pending further validation, this finding may constitute the basis for detection of scar without contrast enhanced imaging, and would result in reduced cost, scan time and risk associated with gadolinium. Acknowledgement/Funding ARP: Research support (software) from Neosoft and Philips

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Correlation between cardiac magnetic resonance feature tracking derived left ventricular strain and morphological characteristics of non-ischemic dilated cardiomyopathy at baseline and follow-up

European Heart Journal ◽

10.1093/eurheartj/ehab724.0230 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

E Pozo Osinalde ◽

J Urmeneta Ulloa ◽

J L Rodriguez Hernandez ◽

L Perez De Isla ◽

H Martinez Fernandez ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Feature Tracking ◽

Systolic Function ◽

Morphological Characteristics ◽

Strain Analysis ◽

Left Ventricular ◽

Morphological Parameters ◽

Non Ischemic Dilated Cardiomyopathy

Abstract Background Left ventricular (LV) strain from echocardiography is a known useful predictor of LVEF recovery in non-ischemic dilated cardiomyopathy (NIDCM). More recently, feature tracking (FT) has allowed LV myocardial deformation analysis using conventional cardiac magnetic resonance (CMR) cine sequences. Purpose Our aim is to establish the correlation between LV strain values from CMR-FT at diagnosis and morphological parameters at baseline and during follow-up. Methods Consecutive patients with NIDCM who underwent CMR were retrospectively collected. All the studies were performed in a 1.5 Tesla magnet following a standard acquisition protocol of conventional SSFP cine sequences in long and short axis. Global longitudinal, circumferential and radial strain (GLS, GCS and GRS, respectively) were obtained with a dedicated FT software. Correlation with CMR morphological parameters at baseline were evaluated. Likewise, in the cases with follow-up echocardiogram association between FT LV strain and evolution of morphofunctional variables was explored. Results CMR-FT strain analysis was performed in 98 patients (age 68±13 years, 72% males) with NIDCM. They showed severe LV dilatation (LVEDVi= 133.6±33.4 mL/m2) and systolic dysfunction (LVEF= 29.5±9.6%) at baseline. Myocardial fibrosis was detected in 38.8% of the patients with late gadolium enhancement (LGE) sequence. All the basal CMR morphological characteristics were significantly correlated with FT strain analysis (Table), even more markedly for GCS. However, there was no association of baseline morphofunctional parameters with LGE. An echocardiogram was performed in 85.7% of the patients during the follow-up (2.4 [1.8–3.4] years), with an LVEF >50% in the 25.5% of the cases. These patients with preserved LVEF in the evolution showed better GCS (−9 vs −7.1%; p=0.019) at baseline, with no differences in the other FT LV strain parameters. Despite less fibrosis in LGE (16.1% vs 37.7%; p=0.037), none of the baseline morphofunctional CMR parameters (LVEF, LVEDVi...) were associated with systolic function restoration. In multivariate analysis, GCS was the only independent predictor (OR 1.16; p=0.045) of LVEF recovery among imaging variables. Conclusions All the FT derived LV strain values were correlated with the degree of basal morphofunctional involvement in NIDCM. Furthermore, GCS emerged as an independent imaging predictor of LV systolic function restoration in our series. FUNDunding Acknowledgement Type of funding sources: None. Table 1. Correlation between myocardial deformation values by feature tracking and morphofunctional variables in basal CMR.

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338Myocardial deformation imaging for the assessment of left ventricular function in arrhythmogenic right ventricular cardiomyopathy: a feature tracking cardiac magnetic resonance study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez122.007 ◽

2019 ◽

Vol 20 (Supplement_2) ◽

Author(s):

D Stolfo ◽

M Della Paolera ◽

A Mazzanti ◽

D Kukavica ◽

G Vitrella ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Left Ventricular Function ◽

Right Ventricular ◽

Ventricular Function ◽

Feature Tracking ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Left Ventricular ◽

Ventricular Cardiomyopathy ◽

Magnetic Resonance Study

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Prognostic significance of cardiac magnetic resonance-based markers in patients with hypertrophic cardiomyopathy

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02165-8 ◽

2021 ◽

Author(s):

Zsofia Dohy ◽

Liliana Szabo ◽

Attila Toth ◽

Csilla Czimbalmos ◽

Rebeka Horvath ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Hypertrophic Cardiomyopathy ◽

Magnetic Resonance ◽

Myocardial Fibrosis ◽

Ventricular Arrhythmias ◽

Prognostic Significance ◽

Strain Analysis ◽

Left Ventricular ◽

Icd Therapy ◽

Lv Mass

AbstractThe prognosis of patients with hypertrophic cardiomyopathy (HCM) varies greatly. Cardiac magnetic resonance (CMR) is the gold standard method for assessing left ventricular (LV) mass and volumes. Myocardial fibrosis can be noninvasively detected using CMR. Moreover, feature-tracking (FT) strain analysis provides information about LV deformation. We aimed to investigate the prognostic significance of standard CMR parameters, myocardial fibrosis, and LV strain parameters in HCM patients. We investigated 187 HCM patients who underwent CMR with late gadolinium enhancement and were followed up. LV mass (LVM) was evaluated with the exclusion and inclusion of the trabeculae and papillary muscles (TPM). Global LV strain parameters and mechanical dispersion (MD) were calculated. Myocardial fibrosis was quantified. The combined endpoint of our study was all-cause mortality, heart transplantation, malignant ventricular arrhythmias and appropriate implantable cardioverter defibrillator (ICD) therapy. The arrhythmia endpoint was malignant ventricular arrhythmias and appropriate ICD therapy. The LVM index (LVMi) was an independent CMR predictor of the combined endpoint independent of the quantification method (p < 0.01). The univariate predictors of the combined endpoint were LVMi, global longitudinal (GLS) and radial strain and longitudinal MD (MDL). The univariate predictors of arrhythmia events included LVMi and myocardial fibrosis. More pronounced LV hypertrophy was associated with impaired GLS and increased MDL. More extensive myocardial fibrosis correlated with impaired GLS (p < 0.001). LVMi was an independent CMR predictor of major events, and myocardial fibrosis predicted arrhythmia events in HCM patients. FT strain analysis provided additional information for risk stratification in HCM patients.

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Incremental value of feature-tracking cardiac magnetic resonance imaging in detecting myocardial dysfunction in patients with idiopathic ventricular arrhythmias

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.275 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

C Nikolaidou ◽

C Kotanidis ◽

J Leal-Pelado ◽

K Kouskouras ◽

VP Vassilikos ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Ventricular Arrhythmias ◽

Feature Tracking ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Volume Index ◽

Control Subjects ◽

Cmr Imaging

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac magnetic resonance (CMR) imaging can identify the underlying substrate in patients with ventricular arrhythmias (VAs) and normal echocardiography. Myocardial strain has emerged as a superior index of systolic performance compared to ejection fraction (EF), with an incremental prognostic value in many cardiac diseases. Purpose To assess myocardial deformation using 2-D feature-tracking CMR strain imaging (CMR-FT) in patients with frequent VAs (≥500 ventricular premature contractions (VPC)/24 hours; and/or non-sustained ventricular tachycardia), and structurally normal hearts on echocardiography without evidence of coronary artery disease. Methods Sixty-eight consecutive patients (mean age 46 ± 16 years; 54% female) and 72 healthy controls matched for age and body surface area were included in the study. CMR imaging was performed on a 1.5T Magnetom Avanto (Siemens, Erlangen, Germany) scanner using a standard cardiac protocol. Results CMR showed normal findings in 30 patients (44%), while 16 (24%) had previous myocarditis, 6 (9%) had a diagnosis of non-ischaemic cardiomyopathy (NICM), 15 (22%) were diagnosed with VPC-related cardiomyopathy, and 1 patient had subendocardial infarction [excluded from strain analysis]. Mean left ventricular EF (LVEF) in patients was 62% ± 6% and right ventricular EF 64% ± 6% (vs. 65% ± 3% and 66% ± 4% in controls, respectively). Compared to control subjects, patients with VAs had impaired peak LV global radial strain (GRS) (28.88% [IQR: 25.87% to 33.97%] vs. 36.65% [IQR:33.19% to 40.2%], p < 0.001) and global circumferential strain (GCS) (-17.73% [IQR: -19.8% to -16.33%] vs. -20.66% [IQR: -21.72% to -19.6%], p < 0.001, Panel A). Peak LV GRS could differentiate patients with previous myocarditis from patients with NICM and those with VPC-related cardiomyopathy (Panel B). Peak LV GCS could differentiate patients with previous myocarditis from patients with NICM (Panel C). Peak LV GRS showed excellent diagnostic accuracy in detecting patients from control subjects (Panel D). In a multivariable regression model, subjects with a low GRS (<29.91%-determined by the Youden’s index) had 5-fold higher odds of having VAs (OR:4.99 [95%CI: 1.2-21.95]), after adjusting for LVEF, LV end-diastolic volume index, age, sex, BMI, smoking, hypertension, and dyslipidaemia. Peak LV global longitudinal strain (GLS) and RV strain indices were not statistically different between patients and controls. Conclusion Peak LV GRS and GCS are impaired in patients with frequent idiopathic VAs and can detect myocardial contractile dysfunction in patients with different underlying substrates. Our findings suggest that LV strain indices on CMR-FT constitute independent markers of myocardial dysfunction on top and independently of EF. Abstract Figure.

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Optimal assessment of right ventricular function using cardiac magnetic resonance cine imaging after Mustard palliation for transposition of the great arteries

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-13-s1-o20 ◽

2011 ◽

Vol 13 (S1) ◽

Author(s):

Laura Jimenez-Juan ◽

Subodh B Joshi ◽

Andrew T Yan ◽

Susan H James ◽

Djeven Deva ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Right Ventricular ◽

Ventricular Function ◽

Right Ventricular Function ◽

Cine Imaging

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Abstract 16584: Abnormal Right Ventricular Strain by Cardiac Magnetic Resonance in Preclinical Arrhythmogenic Right Ventricular Cardiomyopathy

Circulation ◽

10.1161/circ.130.suppl_2.16584 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Davis Vigneault ◽

Anneline S te Riele ◽

Cynthia A James ◽

Stefan L Zimmerman ◽

Hugh Calkins ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Right Ventricular ◽

Feature Tracking ◽

Longitudinal Strain ◽

Wall Motion ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Statistical Significance ◽

Ventricular Cardiomyopathy ◽

Wall Motion Abnormalities

Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by regional wall motion abnormalities of the right ventricle (RV) that have not previously been quantified, resulting in challenges / errors in diagnosis of the disease. RV strain is poorly assessed with tagged cardiac magnetic resonance (CMR) due to the thin RV wall. We applied novel feature tracking analysis to assess RV strain in patients with ARVC. Methods: 106 subjects (30 controls, 37 preclinical ARVC [mutation+], and 39 overt ARVC [mutation+, Task Force+] patients) underwent 4 chamber and axial cine imaging using SSFP sequences. The RV was divided into subtricuspid (ST), anterior wall (AW), and apical (Ap) regions. Each region was analyzed to determine peak longitudinal strain and strain-rate using Multimodality Tissue Tracking (MTT) software (MTT Version 6.0.4725, Toshiba Medical Systems Corporation, Tokyo, Japan). Results: Average age was 33.6 ± 16.1 years (48.2% women); there were no differences between groups. In the 4 chamber view, mean global and segmental strain and strain rates decreased in magnitude from control (-37.7% ± 11.2) to preclinical (-32.2% ± 11.5) to overt ARVC (mean -22.2% ± 11.9). Differences between groups most pronounced in the subtricuspid segment, and reached statistical significance between overt ARVC and both control and preclinical ARVC (p < 0.01). A similar trend was observed in longitudinal strain measured in the axial view, but these trends were inconsistent; statistical significance was met globally, but most individual segments did not reach statistical significance. Conclusions: Longitudinal RV strain as measured by CMR feature tracking in ARVC appears able to quantify wall motion abnormalities in overt ARVC, as well as define subtle abnormalities in patients with preclinical ARVC.

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