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Bernhard B, Joss P, Greisser N, Stark AW, Schütze J, Shiri I, Safarkhanlo Y, Fischer K, Guensch DP, Bastiaansen JAM, Pavlicek M, Benz DC, Kwong RY, Gräni C. Prognostic value of visual and quantitative CMR regional myocardial function in patients with suspected myocarditis. Int J Cardiovasc Imaging 2024; 40:907-920. [PMID: 38427272 PMCID: PMC11052711 DOI: 10.1007/s10554-024-03059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
According to updated Lake-Louise Criteria, impaired regional myocardial function serves as a supportive criterion in diagnosing myocarditis. This study aimed to assess visual regional wall motional abnormalities (RWMA) and novel quantitative regional longitudinal peak strain (RLS) for risk stratification in the clinical setting of myocarditis. In patients undergoing CMR and meeting clinical criteria for suspected myocarditis global longitudinal strain (GLS), late gadolinium enhancement (LGE), RWMA and RLS were assessed in the anterior, septal, inferior, and lateral regions and correlated to the occurrence of major adverse cardiac events (MACE), including heart failure hospitalization, sustained ventricular tachycardia, recurrent myocarditis, and all-cause death. In 690 consecutive patients (age: 48.0 ± 16.0 years; 37.7% female) with suspected myocarditis impaired RLS was correlated with RWMA and LV-GLS but not with the presence of LGE. At median follow up of 3.8 years, MACE occurred in 116 (16.8%) patients. Both, RWMA and RLS in anterior-, septal-, inferior-, and lateral- locations were univariately associated with outcomes (all p < 0.001), but not after adjusting for clinical characteristics and LV-GLS. In the subgroup of patients with normal LV function, RWMA were not predictive of outcomes, whereas septal RLS had incremental and independent prognostic value over clinical characteristics (HRadjusted = 1.132, 95% CI 1.020-1.256; p = 0.020). RWMA and RLS can be used to assess regional impairment of myocardial function in myocarditis but are of limited prognostic value in the overall population. However, in the subgroup of patients with normal LV function, septal RLS represents a distinctive marker of regional LV dysfunction, offering potential for risk-stratification.
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Affiliation(s)
- Benedikt Bernhard
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Philippe Joss
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Noah Greisser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anselm W Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan Schütze
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Isaac Shiri
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasaman Safarkhanlo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Jessica A M Bastiaansen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Translation Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Maryam Pavlicek
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik C Benz
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Cardiology, University Hospital Bern, Freiburgstrasse, CH - 3010, Bern, Switzerland.
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Sun Z, Wang Y, Hu Y, Wu F, Zhang N, Liu Z, Lu J, Li K. Left ventricular dyssynchrony measured by cardiovascular magnetic resonance-feature tracking in anterior ST-elevation myocardial infarction: relationship with microvascular occlusion myocardial damage. Front Cardiovasc Med 2023; 10:1255063. [PMID: 37900576 PMCID: PMC10602888 DOI: 10.3389/fcvm.2023.1255063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives Cardiovascular magnetic resonance-feature tracking (CMR-FT) enables quantification of myocardial deformation and may be used as an objective measure of myocardial involvement in ST-elevation myocardial infarction (STEMI). We sought to investigate the associations between myocardial dyssynchrony parameters and myocardium damage for STEMI. Methods We analyzed 65 patients (45-80 years old) with anterior STEMI after primary percutaneous coronary intervention during 3-7 days [observational (STEMI) group] and 60 healthy volunteers [normal control (NC) group]. Myocardial dyssynchrony parameters were derived, including global and regional strain, radial rebound stretch and displacement, systolic septal time delay, and circumferential stretch. Results CMR characteristics, including morphologic parameters such as left ventricular ejection fraction (LVEF) (45.3% ± 8.2%) and myocardium damage in late gadolinium enhancement (LGE) (19.4% ± 4.7% LV), were assessed in the observation group. The global radial strain (GRS) and global longitudinal strain (GLS) substantially decreased in anterior STEMI compared with the NC group (GRS: 19.4% ± 5.1% vs. 24.8% ± 4.0%, P < 0.05; GLS: -10.1% ± 1.7% vs. -13.7% ± 1.0%, P < 0.05). Among 362 infarcted segments, radial and circumferential peak strains of the infarcted zone were the lowest (14.4% ± 3.2% and -10.7% ± 1.6%, respectively). The radial peak displacement of the infarct zone significantly decreased (2.6 ± 0.4 mm) (P < 0.001) and manifested in the circumferential displacement (3.5° ± 0.7°) in the STEMI group (P < 0.01). As microvascular occlusion (MVO) was additionally present, some strain parameters were significantly impaired in LGE+/MVO+ segments (radial strain [RS]: 12.2% ± 2.1%, circumferential strain [CS]: -9.6% ± 0.7%, longitudinal strain [LS]: -6.8% ± 1.0%) compared to LGE+/MVO- (RS: 14.6% ± 3.2%, CS: -10.8% ± 1.8%, LS: -9.2% ± 1.3%) (P < 0.05). When the extent of transmural myocardial infarction is greater than 75%, the parameter of the systolic septal delay (mean, 148 ms) was significantly reduced compared to fewer degrees of infarction (P < 0.01). Conclusion In anterior STEMI, the infarcted septum swings in a bimodal mode, and myocardial injury reduces the radial strain contractility. A more than 75% transmural degree was the septal strain-contraction reserve cut-off point.
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Affiliation(s)
- Zheng Sun
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yu Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Yingying Hu
- Department of Radiology, The Peking University International Hospital, Beijing, China
| | - Fang Wu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Nan Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Zhi Liu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Kuncheng Li
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
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3
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Barison A, Ceolin R, Palmieri A, Tamborrino PP, Todiere G, Grigoratos C, Gueli IA, De Gori C, Clemente A, Pistoia L, Pepe A, Aquaro GD, Positano V, Emdin M, Cademartiri F, Meloni A. Biventricular Tissue Tracking with Cardiovascular Magnetic Resonance: Reference Values of Left- and Right-Ventricular Strain. Diagnostics (Basel) 2023; 13:2912. [PMID: 37761278 PMCID: PMC10527573 DOI: 10.3390/diagnostics13182912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/31/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
We derived reference values of left-ventricular (LV) and right-ventricular (RV) strain parameters in a cohort of 100 healthy subjects by feature tracking cardiac magnetic resonance (FT-CMR). Global and regional strain values were calculated for the LV; circumferential and radialSAX strain parameters were derived from the short-axis (SAX) stack, while longitudinal and radialLAX strain parameters were assessed in three long-axis (LAX) views. Only global longitudinal strain (GLS) was calculated for the RV. Peak global LV circumferential strain was -16.7% ± 2.1%, LV radialSAX strain was 26.4% ± 5.1%, LV radialLAX strain was 31.1% ± 5.2%, LV GLS was -17.7% ± 1.9%, and RV GLS was -23.9% ± 4.1%. Women presented higher global LV and RV strain values than men; all strain values presented a weak relationship with body surface area, while there was no association with age or heart rate. A significant association was detected between all LV global strain measures and LV ejection fraction, while RV GLS was correlated to RV end-diastolic volume. The intra- and inter-operator reproducibility was good for all global strain measures. In the regional analysis, circumferential and radial strain values resulted higher at the apical level, while longitudinal strain values were higher at the basal level. The assessment of cardiac deformation by FT-CMR is feasible and reproducible and gender-specific reference values should be used.
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Affiliation(s)
- Andrea Barison
- Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Roberto Ceolin
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, 34128 Trieste, Italy
| | - Alessandro Palmieri
- Cardiothoracovascular Department, Careggi University Hospital, 50134 Florence, Italy
| | - Pietro Paolo Tamborrino
- Cardiology Division, Cardiothoracic and Vascular Department, Pisa University Hospital, 56124 Pisa, Italy
| | - Giancarlo Todiere
- Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Chrysanthos Grigoratos
- Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Ignazio Alessio Gueli
- Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Carmelo De Gori
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Alberto Clemente
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Clinical Research Unit, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padua, 35128 Padova, Italy
| | - Giovanni Donato Aquaro
- Academic Radiology Unit, Department of Surgical Medical and Molecular Pathology and Critical Area, University of Pisa, 56124 Pisa, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Department of Bioengineering, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Antonella Meloni
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Department of Bioengineering, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
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Pezel T, Garot P, Toupin S, Hovasse T, Sanguineti F, Champagne S, Morisset S, Chitiboi T, Jacob AJ, Sharma P, Unterseeh T, Garot J. Prognostic impact of artificial intelligence-based fully automated global circumferential strain in patients undergoing stress CMR. Eur Heart J Cardiovasc Imaging 2023; 24:1269-1279. [PMID: 37159403 DOI: 10.1093/ehjci/jead100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/11/2023] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
AIMS To determine whether fully automated artificial intelligence-based global circumferential strain (GCS) assessed during vasodilator stress cardiovascular (CV) magnetic resonance (CMR) can provide incremental prognostic value. METHODS AND RESULTS Between 2016 and 2018, a longitudinal study included all consecutive patients with abnormal stress CMR defined by the presence of inducible ischaemia and/or late gadolinium enhancement. Control subjects with normal stress CMR were selected using a propensity score-matching. Stress-GCS was assessed using a fully automatic machine-learning algorithm based on featured-tracking imaging from short-axis cine images. The primary outcome was the occurrence of major adverse clinical events (MACE) defined as CV mortality or nonfatal myocardial infarction. Cox regressions evaluated the association between stress-GCS and the primary outcome after adjustment for traditional prognosticators. In 2152 patients [66 ± 12 years, 77% men, 1:1 matched patients (1076 with normal and 1076 with abnormal CMR)], stress-GCS was associated with MACE [median follow-up 5.2 (4.8-5.5) years] after adjustment for risk factors in the propensity-matched population [adjusted hazard ratio (HR), 1.12 (95% CI, 1.06-1.18)], and patients with normal CMR [adjusted HR, 1.35 (95% CI, 1.19-1.53), both P < 0.001], but not in patients with abnormal CMR (P = 0.058). In patients with normal CMR, an increased stress-GCS showed the best improvement in model discrimination and reclassification above traditional and stress CMR findings (C-statistic improvement: 0.14; NRI = 0.430; IDI = 0.089, all P < 0.001; LR-test P < 0.001). CONCLUSION Stress-GCS is not a predictor of MACE in patients with ischaemia, but has an incremental prognostic value in those with a normal CMR although the absolute event rate remains low.
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Affiliation(s)
- Théo Pezel
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière-APHP, Inserm UMRS 942, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Solenn Toupin
- Siemens Healthcare France, Scientific partnerships, 93200 Saint-Denis, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Stéphane Champagne
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Stéphane Morisset
- Independent Biostatistician, Université de Paris Cité, Pérouges, France
| | - Teodora Chitiboi
- Siemens Healthineers, Biomedical Engineering, Lindenplatz 2, Germany
| | - Athira J Jacob
- Siemens Healthineers, Digital Technologies and Innovation, 755 College Road East, Princeton NJ 08540, USA
| | - Puneet Sharma
- Siemens Healthineers, Digital Technologies and Innovation, 755 College Road East, Princeton NJ 08540, USA
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
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Chew JD, George-Durrett K, Acheampong B, Weiner JG, Slaughter JC, Parra DA, Soslow JH. Comparison of Strain-Encoding and Feature-Tracking Derived Myocardial Deformation Assessment of Left Ventricular Function in a Pediatric and Adult Congenital Heart Disease Cohort. Pediatr Cardiol 2022; 43:1338-1348. [PMID: 35238958 DOI: 10.1007/s00246-022-02856-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) strain can be assessed with feature-tracking (FT), which utilizes a post-processing algorithm to quantify myocardial deformation on routine cine images, and strain-encoding magnetic resonance imaging (SENC), which uses parallel magnetization tags combined with out-of-plane phase-encoding gradients to quantify deformation. Assessing agreement is critical to determine whether results can be translated between methods. We compared SENC to FT in the assessment of left ventricle (LV) global longitudinal strain (GLS) and global circumferential strain (GCS) in a cohort of pediatric and adult congenital heart disease (ACHD) patients. METHODS Pediatric subjects and ACHD patients underwent CMR on 1.5 T Siemens scanners, including balanced steady-state-free precession (bSSFP) cine imaging and SENC acquisitions in apical two and four chamber, left ventricular outflow tract, and short axis views. bSSFP cine imaging FT analysis was completed with Medis QStrain. Myocardial Solutions MyoStrain was used to analyze SENC. Correlation was assessed by Spearman's rank correlation coefficient. Agreement between techniques was assessed with concordance correlation coefficient (CCC) and Bland-Altman. RESULTS The cohort included 134 patients, 75 with congenital heart disease (56%). The median age was 16.3 years (IQR 13.7, 19.5). Median LV ejection fraction was 57% (IQR 54.4, 61.6). SENC and FT were in poor agreement for GLS (Spearman's ρ = 0.58, p < 0.001; CCC 0.24) and GCS (Spearman's ρ = 0.29, p < 0.001; CCC 0.03). CONCLUSION There was poor agreement between SENC and FT derived GLS and GCS in a cohort of pediatric and ACHD patients, suggesting that SENC and FT cannot be used interchangeably.
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Affiliation(s)
- Joshua D Chew
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Suite 5230, Doctor's Office Tower, Nashville, TN, 37232, USA.
| | - Kristen George-Durrett
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Suite 5230, Doctor's Office Tower, Nashville, TN, 37232, USA
| | - Benjamin Acheampong
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Suite 5230, Doctor's Office Tower, Nashville, TN, 37232, USA
| | - Jeffrey G Weiner
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Suite 5230, Doctor's Office Tower, Nashville, TN, 37232, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David A Parra
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Suite 5230, Doctor's Office Tower, Nashville, TN, 37232, USA
| | - Jonathan H Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Suite 5230, Doctor's Office Tower, Nashville, TN, 37232, USA
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Gräni C, Stark AW, Fischer K, Fürholz M, Wahl A, Erne SA, Huber AT, Guensch DP, Vollenbroich R, Ruberti A, Dobner S, Heg D, Windecker S, Lanz J, Pilgrim T. Diagnostic performance of cardiac magnetic resonance segmental myocardial strain for detecting microvascular obstruction and late gadolinium enhancement in patients presenting after a ST-elevation myocardial infarction. Front Cardiovasc Med 2022; 9:909204. [PMID: 35911559 PMCID: PMC9329615 DOI: 10.3389/fcvm.2022.909204] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMicrovascular obstruction (MVO) and Late Gadolinium Enhancement (LGE) assessed in cardiac magnetic resonance (CMR) are associated with adverse outcome in patients with ST-elevation myocardial infarction (STEMI). Our aim was to analyze the diagnostic performance of segmental strain for the detection of MVO and LGE.MethodsPatients with anterior STEMI, who underwent additional CMR were enrolled in this sub-study of the CARE-AMI trial. Using CMR feature tracking (FT) segmental circumferential peak strain (SCS) was measured and the diagnostic performance of SCS to discriminate MVO and LGE was assessed in a derivation and validation cohort.ResultsForty-eight STEMI patients (62 ± 12 years old), 39 (81%) males, who underwent CMR (i.e., mean 3.0 ± 1.5 days) after primary percutaneous coronary intervention (PCI) were included. All patients presented with LGE and in 40 (83%) patients, MVO was additionally present. Segments in all patients were visually classified and 146 (19%) segments showed MVO (i.e., LGE+/MVO+), 308 (40%) segments showed LGE and no MVO (i.e., LGE+/MVO–), and 314 (41%) segments showed no LGE (i.e., LGE–). Diagnostic performance of SCS for detecting MVO segments (i.e., LGE+/MVO+ vs. LGE+/MVO–, and LGE–) showed an AUC = 0.764 and SCS cut-off value was –11.2%, resulting in a sensitivity of 78% and a specificity of 67% with a positive predictive value (PPV) of 30% and a negative predictive value (NPV) of 94% when tested in the validation group. For LGE segments (i.e., LGE+/MVO+ and LGE+/MVO– vs. LGE–) AUC = 0.848 and SCS with a cut-off value of –13.8% yielded to a sensitivity of 76%, specificity of 74%, PPV of 81%, and NPV of 70%.ConclusionSegmental strain in STEMI patients was associated with good diagnostic performance for detection of MVO+ segments and very good diagnostic performance of LGE+ segments. Segmental strain may be useful as a potential contrast-free surrogate marker to improve early risk stratification in patients after primary PCI.
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Affiliation(s)
- Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Christoph Gräni,
| | - Anselm W. Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kady Fischer
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Monika Fürholz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Wahl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie A. Erne
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik P. Guensch
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - René Vollenbroich
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Ruberti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Dobner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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7
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Steen H, Montenbruck M, Kelle S, Esch S, Schwarz AK, Giusca S, Korosoglou G. Fast-Strain Encoded Cardiac Magnetic Resonance During Vasodilator Perfusion Stress Testing. Front Cardiovasc Med 2021; 8:765961. [PMID: 34869679 PMCID: PMC8635645 DOI: 10.3389/fcvm.2021.765961] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/11/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Cardiac magnetic resonance perfusion imaging during vasodilator stress is an established modality in patients with suspected and known coronary artery disease (CAD). Aim: This study aimed to evaluate the performance of fast-Strain-Encoded-MRI (fast-SENC) for the diagnostic classification and risk stratification of patients with ischemic heart disease. Methods: Perfusion and fast-SENC cardiac magnetic resonance (CMR) images were retrospectively analyzed in 111 patients who underwent stress CMR. The average myocardial perfusion score index, global and segmental longitudinal and circumferential strain (GLS and GCS and SLS and SCS, respectively), were measured at rest and during stress. The combination of SLS and SCS was referred to as segmental aggregate strain (SAS). Segments exhibiting perfusion defects or SAS impairment during stress were defined as "ischemic." All-cause mortality, non-fatal infarction, and urgent revascularization were deemed as our combined clinical endpoint. Results: During adenosine stress testing, 44 of 111 (39.6%) patients exhibited inducible perfusion abnormalities. During a mean follow-up of 1.94 ± 0.65 years, 25 (22.5%) patients reached the combined endpoint (death in n = 2, infarction in n = 3 and urgent revascularization in n = 20). Inducible perfusion defects were associated with higher number of segments with inducible SAS reduction ≥6.5% (χ2 = 37.8, AUC = 0.79, 95% CI = 0.71-0.87, p < 0.001). In addition, patients with inducible perfusion defects or SAS impairment exhibited poorer outcomes (AUCPerf = 0.81 vs. AUCSAS = 0.74, p = NS vs. each other, and χ2 = 30.8, HR = 10.3 and χ2 = 9.5, HR = 3.5, respectively, p < 0.01 for both). Conclusion: Purely quantitative strain analysis by fast-SENC during vasodilator stress was related to the diagnosis of ischemia by first-pass perfusion and is non-inferior for the risk stratification of patients with ischemic heart disease. This may bear clinical implications, especially in patients with contraindications for contrast agent administration.
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Affiliation(s)
| | | | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) (German Centre for Cardiovascular Research), Berlin, Germany
| | - Sebastian Esch
- Cardiology/Cardiac Imaging, Marien Hospital, Hamburg, Germany
| | | | - Sorin Giusca
- Department of Cardiology, Vascular Medicine and Pneumology, Gesundheitszentren Rhein-Neckar (GRN) Hospital Weinheim, Weinheim, Germany.,Cardiac Imaging Center Weinheim, Hector Foundation, Weinheim, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, Vascular Medicine and Pneumology, Gesundheitszentren Rhein-Neckar (GRN) Hospital Weinheim, Weinheim, Germany.,Cardiac Imaging Center Weinheim, Hector Foundation, Weinheim, Germany
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8
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Weise Valdés E, Barth P, Piran M, Laser KT, Burchert W, Körperich H. Left-Ventricular Reference Myocardial Strain Assessed by Cardiovascular Magnetic Resonance Feature Tracking and fSENC-Impact of Temporal Resolution and Cardiac Muscle Mass. Front Cardiovasc Med 2021; 8:764496. [PMID: 34796219 PMCID: PMC8593240 DOI: 10.3389/fcvm.2021.764496] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
Aims: Cardiac strain parameters are increasingly measured to overcome shortcomings of ejection fraction. For broad clinical use, this study provides reference values for the two strain assessment methods feature tracking (FT) and fast strain-encoded (fSENC) cardiovascular magnetic resonance (CMR) imaging, including the child/adolescent group and systematically evaluates the influence of temporal resolution and muscle mass on strain. Methods and Results: Global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain values in 181 participants (54% women, 11–70 years) without cardiac illness were assessed with FT (CVI42® software). GLS and GCS were also analyzed using fSENC (MyoStrain® software) in a subgroup of 84 participants (60% women). Fourteen patients suffering hypertrophic cardiomyopathy (HCM) were examined with both techniques. CMR examinations were done on a 3.0T MR-system. FT-GLS, FT-GCS, and FT-GRS were −16.9 ± 1.8%, −19.2 ± 2.1% and 34.2 ± 6.1%. fSENC-GLS was higher at −20.3 ± 1.8% (p < 0.001). fSENC-GCS was comparable at−19.7 ± 1.8% (p = 0.06). All values were lower in men (p < 0.001). Cardiac muscle mass correlated (p < 0.001) with FT-GLS (r = 0.433), FT-GCS (r = 0.483) as well as FT-GRS (r = −0.464) and acts as partial mediator for sex differences. FT-GCS, FT-GRS and fSENC-GLS correlated weakly with age. FT strain values were significantly lower at lower cine temporal resolutions, represented by heart rates (r = −0.301, −0.379, 0.385) and 28 or 45 cardiac phases per cardiac cycle (0.3–1.9% differences). All values were lower in HCM patients than in matched controls (p < 0.01). Cut-off values were −15.0% (FT-GLS), −19.3% (FT-GCS), 32.7% (FT-GRS), −17.2% (fSENC-GLS), and −17.7% (fSENC-GCS). Conclusion: The analysis of reference values highlights the influence of gender, temporal resolution, cardiac muscle mass and age on myocardial strain values.
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Affiliation(s)
- Elena Weise Valdés
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Peter Barth
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Misagh Piran
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Kai Thorsten Laser
- Center for Congenital Heart Defects, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Wolfgang Burchert
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Hermann Körperich
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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9
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Steen H, Giusca S, Montenbruck M, Patel AR, Pieske B, Florian A, Erley J, Kelle S, Korosoglou G. Left and right ventricular strain using fast strain-encoded cardiovascular magnetic resonance for the diagnostic classification of patients with chronic non-ischemic heart failure due to dilated, hypertrophic cardiomyopathy or cardiac amyloidosis. J Cardiovasc Magn Reson 2021; 23:45. [PMID: 33823860 DOI: 10.1186/s12968-021-00711-w.pmid:33823860;pmcid:pmc8025329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/20/2021] [Indexed: 05/25/2023] Open
Abstract
AIMS To compare the ability of left ventricular (LV) and right ventricular (RV) strain measured by fast-strain encoded cardiovascular magnetic resonance (CMR) (fast-SENC) with LV- and RV-ejection fraction for the diagnostic classification of patients with different stages of chronic heart failure (stages A-D based on American College of Cardiology/American Heart Association guidelines) due to non-ischemic cardiomyopathies. METHODS Our study population consisted of 276 consecutive patients who underwent CMR for clinical reasons, and 19 healthy subjects. Wall motion score index and non-infarct related late gadolinium enhancement (LGE), LV ejection fraction (LVEF) and RV ejection fraction (RVEF) and global LV- and RV-longitudinal (GLS) and circumferential strain (GCS) based on fast-SENC acquisitions, were calculated in all subjects. The percentage of LV and RV myocardial segments with strain ≤ - 17% (%normal LV and RV myocardium) was determined in all subjects. RESULTS LVEF and RVEF, LV-GLS, LV-GCS, RV-GLS, RV-GCS and %normal LV- and RV myocardium depressed with increasing heart failure stage (p < 0.001 for all by ANOVA). By multivariable analysis, %normal LV and RV myocardium exhibited closer associations to heart failure stages than LVEF and RVEF (rpartial = 0.79 versus rpartial = 0.21 for %normal LV myocardium versus LVEF and rpartial = 0.64 versus rpartial = 0.20 for %normal RV myocardium versus RVEF, respectively). Furthermore, %normal LV and RV myocardium exhibited incremental value for the identification of patients (i) with subclinical myocardial dysfunction and (ii) with symptomatic heart failure, surpassing that provided by LVEF and RVEF (ΔAUC = 0.22 for LVEF and ΔAUC = 0.19 for RVEF with subclinical dysfunction, and ΔAUC = 0.19 for LVEF and ΔAUC = 0.22 for RVEF with symptomatic heart failure, respectively, p < 0.001 for all). %normal LV myocardium reclassified 11 of 31 (35%) patients judged as having no structural heart disease by clinical and imaging data to stage B, i.e., subclinical LV-dysfunction. CONCLUSIONS In patients with non-ischemic cardiomyopathy, %normal LV and RV myocardium, by fast-SENC, enables improved identification of asymptomatic patients with subclinical LV-dysfunction. This technique may be useful for the early identification of such presumably healthy subjects at risk for heart failure and for monitoring LV and RV deformation during pharmacologic interventions in future studies.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Amyloidosis/complications
- Amyloidosis/diagnostic imaging
- Amyloidosis/physiopathology
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnostic imaging
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/physiopathology
- Case-Control Studies
- Early Diagnosis
- Female
- Heart Failure/diagnostic imaging
- Heart Failure/etiology
- Heart Failure/physiopathology
- Humans
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Risk Assessment
- Risk Factors
- Stroke Volume
- Ventricular Function, Left
- Ventricular Function, Right
- Young Adult
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Affiliation(s)
- Henning Steen
- Department of Cardiology, Marien Hospital Hamburg, Hamburg, Germany
| | - Sorin Giusca
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Academic Teaching Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany
| | | | - Amit R Patel
- Department of Medicine, University of Chicago, Illinois, USA
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Andre Florian
- Departments of Cardiology, Angiology and Pneumology, Heidelberg University, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Berlin, Germany
| | - Jennifer Erley
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Grigorios Korosoglou
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Academic Teaching Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany.
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10
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Steen H, Giusca S, Montenbruck M, Patel AR, Pieske B, Florian A, Erley J, Kelle S, Korosoglou G. Left and right ventricular strain using fast strain-encoded cardiovascular magnetic resonance for the diagnostic classification of patients with chronic non-ischemic heart failure due to dilated, hypertrophic cardiomyopathy or cardiac amyloidosis. J Cardiovasc Magn Reson 2021; 23:45. [PMID: 33823860 PMCID: PMC8025329 DOI: 10.1186/s12968-021-00711-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/20/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS To compare the ability of left ventricular (LV) and right ventricular (RV) strain measured by fast-strain encoded cardiovascular magnetic resonance (CMR) (fast-SENC) with LV- and RV-ejection fraction for the diagnostic classification of patients with different stages of chronic heart failure (stages A-D based on American College of Cardiology/American Heart Association guidelines) due to non-ischemic cardiomyopathies. METHODS Our study population consisted of 276 consecutive patients who underwent CMR for clinical reasons, and 19 healthy subjects. Wall motion score index and non-infarct related late gadolinium enhancement (LGE), LV ejection fraction (LVEF) and RV ejection fraction (RVEF) and global LV- and RV-longitudinal (GLS) and circumferential strain (GCS) based on fast-SENC acquisitions, were calculated in all subjects. The percentage of LV and RV myocardial segments with strain ≤ - 17% (%normal LV and RV myocardium) was determined in all subjects. RESULTS LVEF and RVEF, LV-GLS, LV-GCS, RV-GLS, RV-GCS and %normal LV- and RV myocardium depressed with increasing heart failure stage (p < 0.001 for all by ANOVA). By multivariable analysis, %normal LV and RV myocardium exhibited closer associations to heart failure stages than LVEF and RVEF (rpartial = 0.79 versus rpartial = 0.21 for %normal LV myocardium versus LVEF and rpartial = 0.64 versus rpartial = 0.20 for %normal RV myocardium versus RVEF, respectively). Furthermore, %normal LV and RV myocardium exhibited incremental value for the identification of patients (i) with subclinical myocardial dysfunction and (ii) with symptomatic heart failure, surpassing that provided by LVEF and RVEF (ΔAUC = 0.22 for LVEF and ΔAUC = 0.19 for RVEF with subclinical dysfunction, and ΔAUC = 0.19 for LVEF and ΔAUC = 0.22 for RVEF with symptomatic heart failure, respectively, p < 0.001 for all). %normal LV myocardium reclassified 11 of 31 (35%) patients judged as having no structural heart disease by clinical and imaging data to stage B, i.e., subclinical LV-dysfunction. CONCLUSIONS In patients with non-ischemic cardiomyopathy, %normal LV and RV myocardium, by fast-SENC, enables improved identification of asymptomatic patients with subclinical LV-dysfunction. This technique may be useful for the early identification of such presumably healthy subjects at risk for heart failure and for monitoring LV and RV deformation during pharmacologic interventions in future studies.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Amyloidosis/complications
- Amyloidosis/diagnostic imaging
- Amyloidosis/physiopathology
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnostic imaging
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/physiopathology
- Case-Control Studies
- Early Diagnosis
- Female
- Heart Failure/diagnostic imaging
- Heart Failure/etiology
- Heart Failure/physiopathology
- Humans
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Risk Assessment
- Risk Factors
- Stroke Volume
- Ventricular Function, Left
- Ventricular Function, Right
- Young Adult
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Affiliation(s)
- Henning Steen
- Department of Cardiology, Marien Hospital Hamburg, Hamburg, Germany
| | - Sorin Giusca
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Academic Teaching Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany
| | | | - Amit R Patel
- Department of Medicine, University of Chicago, Illinois, USA
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Andre Florian
- Departments of Cardiology, Angiology and Pneumology, Heidelberg University, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Berlin, Germany
| | - Jennifer Erley
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Grigorios Korosoglou
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Academic Teaching Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany.
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11
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Lim C, Blaszczyk E, Riazy L, Wiesemann S, Schüler J, von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Quantification of myocardial strain assessed by cardiovascular magnetic resonance feature tracking in healthy subjects-influence of segmentation and analysis software. Eur Radiol 2020; 31:3962-3972. [PMID: 33277669 PMCID: PMC8128822 DOI: 10.1007/s00330-020-07539-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 09/16/2020] [Accepted: 11/17/2020] [Indexed: 01/01/2023]
Abstract
Objectives Quantification of myocardial deformation by feature tracking is of growing interest in cardiovascular magnetic resonance. It allows the assessment of regional myocardial function based on cine images. However, image acquisition, post-processing, and interpretation are not standardized. We aimed to assess the influence of segmentation procedure such as slice selection and different types of analysis software on values and quantification of myocardial strain in healthy adults. Methods Healthy volunteers were retrospectively analyzed. Post-processing was performed using CVI42 and TomTec. Longitudinal and radialLong axis (LAX) strain were quantified using 4-chamber-view, 3-chamber-view, and 2-chamber-view. Circumferential and radialShort axis (SAX) strain were assessed in basal, midventricular, and apical short-axis views and using full coverage. Global and segmental strain values were compared to each other regarding their post-processing approach and analysis software package. Results We screened healthy volunteers studied at 1.5 or 3.0 T and included 67 (age 44.3 ± 16.3 years, 31 females). Circumferential and radialSAX strain values were different between a full coverage approach vs. three short slices (− 17.6 ± 1.8% vs. − 19.2 ± 2.3% and 29.1 ± 4.8% vs. 34.6 ± 7.1%). Different analysis software calculated significantly different strain values. Within the same vendor, different field strengths (− 17.0 ± 2.1% at 1.5 T vs. − 17.0 ± 1.7% at 3 T, p = 0.845) did not influence the calculated global longitudinal strain (GLS), and were similar in gender (− 17.4 ± 2.0% in females vs. − 16.6 ± 1.8% in males, p = 0.098). Circumferential and radial strain were different in females and males (circumferential strain − 18.2 ± 1.7% vs. − 17.1 ± 1.8%, p = 0.029 and radial strain 30.7 ± 4.7% vs. 27.8 ± 4.6%, p = 0.047). Conclusions Myocardial deformation assessed by feature tracking depends on segmentation procedure and type of analysis software. CircumferentialSAX and radialSAX depend on the number of slices used for feature tracking analysis. As known from other imaging modalities, GLS seems to be the most stable parameter. During follow-up studies, standardized conditions should be warranted. Trial registration Retrospectively registered Key Points • Myocardial deformation assessed by feature tracking depends on the segmentation procedure. • Global myocardial strain values differ significantly among vendors. • Standardization in post-processing using CMR feature tracking is essential. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-020-07539-5.
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Affiliation(s)
- Carolin Lim
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Edyta Blaszczyk
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Leili Riazy
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
- Berlin Ultrahigh Field Facility at the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Stephanie Wiesemann
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Johannes Schüler
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Florian von Knobelsdorff-Brenkenhoff
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
- Department of Cardiology, Clinic Agatharied, Ludwig-Maximilians - University München, Hausham, Germany
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany.
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12
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Backhaus SJ, Metschies G, Zieschang V, Erley J, Mahsa Zamani S, Kowallick JT, Lapinskas T, Pieske B, Lotz J, Kutty S, Hasenfuß G, Kelle S, Schuster A. Head-to-head comparison of cardiovascular MR feature tracking cine versus acquisition-based deformation strain imaging using myocardial tagging and strain encoding. Magn Reson Med 2020; 85:357-368. [PMID: 32851707 DOI: 10.1002/mrm.28437] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/29/2020] [Accepted: 06/26/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Myocardial feature-tracking (FT) deformation imaging is superior for risk stratification compared with volumetric approaches. Because there is no clear recommendation regarding FT postprocessing, we compared different FT-strain analyses with reference standard techniques, including tagging and strain-encoded (SENC) MRI. METHODS Feature-tracking software from four different vendors (TomTec, Medis, Circle [CVI], and Neosoft), tagging (Segment), and fastSENC (MyoStrain) were used to determine left ventricular global circumferential strains (GCS) and longitudinal strains (GLS) in 12 healthy volunteers and 12 patients with heart failure. Variability and agreements were assessed using intraclass correlation coefficients for absolute agreement (ICCa) and consistency (ICCc) as well as Pearson correlation coefficients. RESULTS For FT-GCS, consistency was excellent comparing different FT vendors (ICCc = 0.84-0.97, r = 0.86-0.95) and in comparison to fast SENC (ICCc = 0.78-0.89, r = 0.73-0.81). FT-GCS consistency was excellent compared with tagging (ICCc = 0.79-0.85, r = 0.74-0.77) except for TomTec (ICCc = 0.68, r = 0.72). Absolute FT-GCS agreements among FT vendors were highest for CVI and Medis (ICCa = 0.96) and lowest for TomTec and Neosoft (ICCa = 0.32). Similarly, absolute FT-GCS agreements were excellent for CVI and Medis compared with both tagging and fast SENC (ICCa = 0.84-0.88), good to excellent for Neosoft (ICCa = 0.77 and 0.64), and lowest for TomTec (ICCa = 0.41 and 0.47). For FT-GLS, consistency was excellent (ICCc ≥ 0.86, r ≥ 0.76). Absolute agreements among FT vendors were excellent (ICCa = 0.91-0.93) or good to excellent for TomTec (ICCa = 0.69-0.85). Absolute agreements (ICCa) were good (CVI 0.70, Medis 0.60) and fair (TomTec 0.41, Neosoft 0.59) compared with tagging, but excellent compared with fast SENC (ICCa = 0.77-0.90). CONCLUSION Although absolute agreements differ depending on deformation assessment approaches, consistency and correlation are consistently high regardless of the method chosen, thus indicating reliable strain assessment. Further standardisation and introduction of uniform references is warranted for routine clinical implementation.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
| | - Georg Metschies
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
| | - Victoria Zieschang
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Jennifer Erley
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Seyedeh Mahsa Zamani
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research, Göttingen, Göttingen, Germany.,University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Tomas Lapinskas
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany.,German Centre for Cardiovascular Research, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Burkert Pieske
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany.,German Centre for Cardiovascular Research, Berlin, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research, Göttingen, Göttingen, Germany.,German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany.,German Centre for Cardiovascular Research, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
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13
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Li W. Biomechanics of infarcted left Ventricle-A review of experiments. J Mech Behav Biomed Mater 2020; 103:103591. [PMID: 32090920 DOI: 10.1016/j.jmbbm.2019.103591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 01/14/2023]
Abstract
Myocardial infarction (MI) is one of leading diseases to contribute to annual death rate of 5% in the world. In the past decades, significant work has been devoted to this subject. Biomechanics of infarcted left ventricle (LV) is associated with MI diagnosis, understanding of remodelling, MI micro-structure and biomechanical property characterizations as well as MI therapy design and optimization, but the subject has not been reviewed presently. In the article, biomechanics of infarcted LV was reviewed in terms of experiments achieved in the subject so far. The concerned content includes experimental remodelling, kinematics and kinetics of infarcted LVs. A few important issues were discussed and several essential topics that need to be investigated further were summarized. Microstructure of MI tissue should be observed even carefully and compared between different methods for producing MI scar in the same animal model, and eventually correlated to passive biomechanical property by establishing innovative constitutive laws. More uniaxial or biaxial tensile tests are desirable on MI, border and remote tissues, and viscoelastic property identification should be performed in various time scales. Active contraction experiments on LV wall with MI should be conducted to clarify impaired LV pumping function and supply necessary data to the function modelling. Pressure-volume curves of LV with MI during diastole and systole for the human are also desirable to propose and validate constitutive laws for LV walls with MI.
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Affiliation(s)
- Wenguang Li
- School of Engineering, University of Glasgow, Glasgow, G12 8QQ, UK.
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14
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Romano S, Romer B, Evans K, Trybula M, Shenoy C, Kwong RY, Farzaneh-Far A. Prognostic Implications of Blunted Feature-Tracking Global Longitudinal Strain During Vasodilator Cardiovascular Magnetic Resonance Stress Imaging. JACC Cardiovasc Imaging 2020; 13:58-65. [PMID: 31005520 PMCID: PMC6745296 DOI: 10.1016/j.jcmg.2019.03.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the prognostic value of feature-tracking global longitudinal strain (GLS) measured during vasodilator stress cardiac magnetic resonance (CMR) imaging. BACKGROUND Prior studies have suggested that blunted myocardial strain during dobutamine stress echocardiography may be associated with adverse prognosis. Recent developments in CMR feature-tracking techniques now allow assessment of strain in clinical practice using standard cine images without specialized pulse sequences or complex post-processing. Whether feature-tracking GLS measured during vasodilator stress provides independent and incremental prognostic data is unclear. METHODS Consecutive patients undergoing stress perfusion CMR were prospectively enrolled (n = 535). Feature-tracking stress GLS was measured immediately after regadenoson perfusion. Patients were followed for major adverse cardiac events (MACE): death, nonfatal myocardial infarction, heart failure hospitalization, sustained ventricular tachycardia, and late revascularization. Cox proportional hazards regression modeling was used to examine the association between stress GLS and MACE. The incremental prognostic value of stress GLS was assessed in nested models. RESULTS Over a median follow-up of 1.5 years, 82 patients experienced MACE. By Kaplan-Meier analysis, patients with stress GLS ≥ median (-19%) had significantly reduced event-free survival compared with those with stress GLS < median (log-rank p < 0.001). Stress GLS was significantly associated with risk of MACE after adjustment for clinical and imaging risk factors including ischemia, ejection fraction, and late gadolinium enhancement (hazard ratio: 1.267; p < 0.001). Addition of stress GLS into a model with clinical and imaging predictors resulted in significant increase in the C-index (from 0.80 to 0.85; p = 0.031) and a continuous net reclassification improvement of 0.898 (95% confidence interval: 0.565 to 1.124). CONCLUSIONS Feature-tracking stress GLS measured during vasodilator stress CMR is an independent predictor of MACE in patients with known or suspected coronary artery disease, incremental to common clinical and imaging risk factors. These findings suggest a role for feature-tracking derived stress GLS in identifying patients at highest risk of adverse events following stress CMR.
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Affiliation(s)
- Simone Romano
- Department of Medicine, University of Verona, Verona, Italy
| | - Benjamin Romer
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Kaleigh Evans
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Michael Trybula
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Chetan Shenoy
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Raymond Y Kwong
- Division of Cardiology, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina.
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15
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Korosoglou G, Giusca S. Strain for Stress Testing. JACC Cardiovasc Imaging 2020; 13:66-68. [DOI: 10.1016/j.jcmg.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 11/28/2022]
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16
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Bucius P, Erley J, Tanacli R, Zieschang V, Giusca S, Korosoglou G, Steen H, Stehning C, Pieske B, Pieske-Kraigher E, Schuster A, Lapinskas T, Kelle S. Comparison of feature tracking, fast-SENC, and myocardial tagging for global and segmental left ventricular strain. ESC Heart Fail 2019; 7:523-532. [PMID: 31800152 PMCID: PMC7160507 DOI: 10.1002/ehf2.12576] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/10/2019] [Accepted: 11/11/2019] [Indexed: 01/11/2023] Open
Abstract
AIMS A multitude of cardiac magnetic resonance (CMR) techniques are used for myocardial strain assessment; however, studies comparing them are limited. We sought to compare global longitudinal (GLS), circumferential (GCS), segmental longitudinal (SLS), and segmental circumferential (SCS) strain values, as well as reproducibility between CMR feature tracking (FT), tagging (TAG), and fast-strain-encoded (fast-SENC) CMR techniques. METHODS AND RESULTS Eighteen subjects (11 healthy volunteers and seven patients with heart failure) underwent two CMR scans (1.5T, Philips) with identical parameters. Global and segmental strain values were measured using FT (Medis), TAG (Medviso), and fast-SENC (Myocardial Solutions). Friedman's test, linear regression, Pearson's correlation coefficient, and Bland-Altman analyses were used to assess differences and correlation in measured GLS and GCS between the techniques. Two-way mixed intra-class correlation coefficient (ICC), coefficient of variance (COV), and Bland-Altman analysis were used for reproducibility assessment. All techniques correlated closely for GLS (Pearson's r: 0.86-0.92) and GCS (Pearson's r: 0.85-0.94). Intra-observer and inter-observer reproducibility was excellent in all techniques for both GLS (ICC 0.92-0.99, CoV 2.6-10.1%) and GCS (ICC 0.89-0.99, CoV 4.3-10.1%). Inter-study reproducibility was similar for all techniques for GLS (ICC 0.91-0.96, CoV 9.1-10.8%) and GCS (ICC 0.95-0.97, CoV 7.6-10.4%). Combined segmental intra-observer reproducibility was good in all techniques for SLS (ICC 0.914-0.953, CoV 12.35-24.73%) and SCS (ICC 0.885-0.978, CoV 10.76-19.66%). Combined inter-study SLS reproducibility was the worst in FT (ICC 0.329, CoV 42.99%), while fast-SENC performed the best (ICC 0.844, CoV 21.92%). TAG had the best reproducibility for combined inter-study SCS (ICC 0.902, CoV 19.08%), while FT performed the worst (ICC 0.766, CoV 32.35%). Bland-Altman analysis revealed considerable inter-technique biases for GLS (FT vs. fast-SENC 3.71%; FT vs. TAG 8.35%; and TAG vs. fast-SENC 4.54%) and GCS (FT vs. fast-SENC 2.15%; FT vs. TAG 6.92%; and TAG vs. fast-SENC 2.15%). Limits of agreement for GLS ranged from ±3.1 (TAG vs. fast-SENC) to ±4.85 (FT vs. TAG) for GLS and ±2.98 (TAG vs. fast-SENC) to ±5.85 (FT vs. TAG) for GCS. CONCLUSIONS We found significant differences in measured GLS and GCS between FT, TAG, and fast-SENC. Global strain reproducibility was excellent for all techniques. Acquisition-based techniques had better reproducibility than FT for segmental strain.
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Affiliation(s)
- Paulius Bucius
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jennifer Erley
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Radu Tanacli
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Victoria Zieschang
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Sorin Giusca
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Grigorious Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Henning Steen
- Department of Internal Medicine/Cardiology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | | | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Tomas Lapinskas
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
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17
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Korosoglou G, Giusca S, Hofmann NP, Patel AR, Lapinskas T, Pieske B, Steen H, Katus HA, Kelle S. Strain-encoded magnetic resonance: a method for the assessment of myocardial deformation. ESC Heart Fail 2019; 6:584-602. [PMID: 31021534 PMCID: PMC6676282 DOI: 10.1002/ehf2.12442] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/28/2019] [Indexed: 12/26/2022] Open
Abstract
This study aims to assess the usefulness of strain‐encoded magnetic resonance (SENC) for the quantification of myocardial deformation (‘strain’) in healthy volunteers and for the diagnostic workup of patients with different cardiovascular pathologies. SENC was initially described in the year 2001. Since then, the SENC sequence has undergone several technical developments, aiming at the detection of strain during single‐heartbeat acquisitions (fast‐SENC). Experimental and clinical studies that used SENC and fast‐SENC or compared SENC with conventional cine or tagged magnetic resonance in phantoms, animals, healthy volunteers, or patients were systematically searched for in PubMed. Using ‘strain‐encoded magnetic resonance and SENC’ as keywords, three phantom and three animal studies were identified, along with 27 further clinical studies, involving 185 healthy subjects and 904 patients. SENC (i) enabled reproducible assessment of myocardial deformation in vitro, in animals and in healthy volunteers, (ii) showed high reproducibility and substantially lower time spent compared with conventional tagging, (iii) exhibited incremental value to standard cine imaging for the detection of inducible ischaemia and for the risk stratification of patients with ischaemic heart disease, and (iv) enabled the diagnostic classification of patients with transplant vasculopathy, cardiomyopathies, pulmonary hypertension, and diabetic heart disease. SENC has the potential to detect a wide range of myocardial diseases early, accurately, and without the need of contrast agent injection, possibly enabling the initiation of specific cardiac therapies during earlier disease stages. Its one‐heartbeat acquisition mode during free breathing results in shorter cardiovascular magnetic resonance protocols, making its implementation in the clinical realm promising.
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Affiliation(s)
- Grigorios Korosoglou
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Sorin Giusca
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Nina P Hofmann
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Amit R Patel
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Burkert Pieske
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
| | - Henning Steen
- Department of Cardiology, Marien Hospital Hamburg, Hamburg, Germany
| | - Hugo A Katus
- Departments of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Sebastian Kelle
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
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18
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Backhaus SJ, Metschies G, Billing M, Kowallick JT, Gertz RJ, Lapinskas T, Pieske B, Lotz J, Bigalke B, Kutty S, Hasenfuß G, Beerbaum P, Kelle S, Schuster A. Cardiovascular magnetic resonance imaging feature tracking: Impact of training on observer performance and reproducibility. PLoS One 2019; 14:e0210127. [PMID: 30682045 PMCID: PMC6347155 DOI: 10.1371/journal.pone.0210127] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/16/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance feature tracking (CMR-FT) is increasingly used for myocardial deformation assessment including ventricular strain, showing prognostic value beyond established risk markers if used in experienced centres. Little is known about the impact of appropriate training on CMR-FT performance. Consequently, this study aimed to evaluate the impact of training on observer variance using different commercially available CMR-FT software. METHODS Intra- and inter-observer reproducibility was assessed prior to and after dedicated one-hour observer training. Employed FT software included 3 different commercially available platforms (TomTec, Medis, Circle). Left (LV) and right (RV) ventricular global longitudinal as well as LV circumferential and radial strains (GLS, GCS and GRS) were studied in 12 heart failure patients and 12 healthy volunteers. RESULTS Training improved intra- and inter-observer reproducibility. GCS and LV GLS showed the highest reproducibility before (ICC >0.86 and >0.81) and after training (ICC >0.91 and >0.92). RV GLS and GRS were more susceptible to tracking inaccuracies and reproducibility was lower. Inter-observer reproducibility was lower than intra-observer reproducibility prior to training with more pronounced improvements after training. Before training, LV strain reproducibility was lower in healthy volunteers as compared to patients with no differences after training. Whilst LV strain reproducibility was sufficient within individual software solutions inter-software comparisons revealed considerable software related variance. CONCLUSION Observer experience is an important source of variance in CMR-FT derived strain assessment. Dedicated observer training significantly improves reproducibility with most profound benefits in states of high myocardial contractility and potential to facilitate widespread clinical implementation due to optimized robustness and diagnostic performance.
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Affiliation(s)
- Sören J. Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Georg Metschies
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Marcus Billing
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Roman J. Gertz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Tomas Lapinskas
- German Heart Center Berlin (DHZB), University of Berlin, Department of Internal Medicine / Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Burkert Pieske
- German Heart Center Berlin (DHZB), University of Berlin, Department of Internal Medicine / Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Boris Bigalke
- Charité Campus Benjamin Franklin, University Medical Center Berlin, Department of Cardiology and Pneumology, Berlin, Germany
| | - Shelby Kutty
- Children's Hospital and Medical Center, University of Nebraska College of Medicine, Omaha, United States of America
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Philipp Beerbaum
- Hanover Medical School, Department of Pediatric Cardiology and Intensive Care, Hanover, Germany
| | - Sebastian Kelle
- German Heart Center Berlin (DHZB), University of Berlin, Department of Internal Medicine / Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Nothern Clinical School, University of Sydney, Sydney, Australia
- * E-mail:
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