Left Ventricular Deformation in Patients with Connective Tissue Disease: Evaluated by 3.0T Cardiac Magnetic Resonance Tissue Tracking

Interaction between the left ventricular ejection fraction and left ventricular strain and its relationship with coronary stenosis

BACKGROUND

Coronary artery stenosis (CAS) is the most common type of heart disease and the leading cause of death in both men and women globally. CAS occurs when the arteries that supply blood to the heart muscle harden and become narrower due to plaque buildup - cholesterol and other material - on their inner walls. As a result, the heart muscle cannot receive the blood or oxygen it needs. Most heart attacks happen when a blood clot suddenly cuts off the hearts' blood supply, causing permanent heart damage.

AIM

To analyze the relationship between the left ventricular ejection fraction (LVEF), left ventricular strain (LVS), and coronary stenosis.

METHODS

A total of 190 participants were enrolled in this trail. The control group comprised 93 healthy individuals, and observation group comprised 97 patients with coronary heart disease who were hospitalized between July 2020 and September 2021. Coronary lesions were assessed using the Gensini score, and the LVEF and LVS were measured using magnetic resonance imaging (MRI). The interaction between the LVEF and LVS was examined using a linear regression model. The relationship between LVEF and coronary stenosis was examined using Spearman’s correlation.

RESULTS

The LVEF of the observation group was lower than that of the control group. The left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV) of the observation group were significantly higher than those of the control group (P < 0.05). The longitudinal and circumferential strains (LS, CS) of the observation group were significantly higher than those of the control group; however, the radial strain (RS) of the observation group was significantly lower than that of the control group (P < 0.05). LVS, LS, and CS were significantly negatively correlated with the LVEF, and RS was positively correlated with the LVEF. There were significant differences in the LVEF, LVESV, and LVEDV of patients with different Gensini scores; the LVEF significantly decreased and the LVESV and LVEDV increased with increasing Gensini scores (P < 0.05). In the observation group, the LVEF was negatively correlated and the LVESV and LVEDV were positively correlated with coronary stenosis (P < 0.05).

CONCLUSION

The LVEF measured using MRI is significantly linearly correlated with LVS and negatively correlated with coronary stenosis.

Early cardiac involvement detected by cardiac magnetic resonance feature tracking in idiopathic inflammatory myopathy with preserved ejection fraction

Cardiac involvement is common in idiopathic inflammatory myopathy (IIM) but often subclinical. Cardiac magnetic resonance (CMR) is a promising tool in detecting cardiac involvement in patients with IIM. The aim of this study was to assess cardiac involvement in IIM patients by CMR feature tracking (CMR-FT). Thirty-seven IIM patients and 25 controls were enrolled in this retrospective study. The left ventricular (LV) functional parameters such as volume and ejection fraction were measured. Global and regional LV peak strain (PS) in radial, circumferential and longitudinal directions were derived from cine images. Left atrial (LA) volume, longitudinal strain and strain rate (SR) parameters and LA reservoir function, conduit function and booster pump function were assessed, respectively. IIM patients with preserved LVEF showed significantly reduced global and regional LV PS in longitudinal direction (all p < 0.05). Compared with controls, LA reservoir and conduit function were significantly impaired in IIM patients (all p < 0.05). The global LV longitudinal PS, LAVpre-ac and SRe were independent predictors of IIM. By Pearson's correlation analysis, the LV global radial, circumferential and longitudinal PS were all correlated to LVEF in IIM patients (r = 0.526, p < 0.001 vs. r = - 0.514, p < 0.001 vs. r = - 0.288, p = 0.023). CMR-FT based LV and LA deformation performance could early detect cardiac involvement in IIM patients with preserved LVEF.

Characterization and clinical significance of biventricular mechanics in patients with systemic lupus erythematosus by 3T cardiovascular magnetic resonance tissue tracking

BACKGROUND

Detecting impaired left ventricle (LV) or right ventricle (RV) mechanics could aid in fully understanding the process of cardiac involvement in patients with systemic lupus erythematosus (SLE). This study aimed to evaluate biventricular strain parameters derived from cardiac magnetic resonance (CMR) tissue tracking in SLE patients and their association with other clinical variables.

METHODS

A group of 47 SLE patients and 27 healthy controls were enrolled and underwent CMR examination, including cine and late gadolinium enhancement (LGE) imaging. Aside from RV strain parameters in the radial direction, biventricular global peak strain and peak systolic/diastolic global strain rate in radial, circumferential, and longitudinal directions were assessed for each participant. Multivariate linear regression analysis was used to analyze the factors related to the biventricular strain parameters. Receiver operating characteristic (ROC) analysis was used to identify RV dysfunction.

RESULTS

Compared with the controls, part of the biventricular strain parameters in the SLE subgroup with preserved ejection fraction (EF) were impaired, which was more significant in the SLE subgroup with reduced EF (all P<0.05). The SLE patients with RV dysfunction (15/47) included patients with LV dysfunction (8/47). The RVEF was associated with impaired LV global peak strain and peak diastolic strain rate in the SLE patients (absolute value of β=0.406-0.715, all P<0.05). The LV LGE in SLE patients (12/47) was associated with LV global longitudinal peak strain and peak diastolic global longitudinal strain rate (β=0.378 and -0.342; all P<0.05). There were independent correlations between pulmonary arterial hypertension and RV global longitudinal peak strain, anti-ribonucleoprotein (RNP) antibody and RV global circumferential peak strain, and pericardial effusion and RV peak diastolic global circumferential strain rate, respectively (β=0.319, 0.359, and -0.285, respectively; all P<0.05). The LV global longitudinal peak strain had greater diagnostic accuracy for RV dysfunction RV dysfunction [area under curve (AUC): 0.933, cut-off value: -13.38%).

CONCLUSIONS

Biventricular strain parameters derived from CMR are sensitive markers of subclinical ventricular function impairment before EF reduction at an early stage of SLE. Biventricular strain analysis could be considered for inclusion in early cardiac functional assessment in SLE patients, particularly LV global longitudinal peak strain, which might assist in therapeutic decision-making and disease monitoring.

Association of left ventricular systolic dysfunction with coronary artery dilation in Kawasaki disease patients: Assessment with cardiovascular magnetic resonance

PURPOSE

To quantify global and regional left ventricular (LV) strain parameters in patients with Kawasaki disease (KD) using cardiovascular magnetic resonance (CMR) tissue tracking and assess the association of coronary artery dilation (CA dilation) with LV systolic dysfunction.

METHODS

Thirty-one KD patients with CA dilation, 22 patients without CA dilation and 27 age- and sex-matched normal controls underwent 3.0 T CMR examination. Z score of >2 was defined as CA dilation. Global LV strain parameters and regional LV strain parameters in 16 American Heart Association segmentation, including radial, circumferential and longitudinal peak strain (PS) and LV function were measured and compared among groups.

RESULTS

No significant difference in LV ejection fraction has been observed among controls, KD patients with CA dilation and without CA dilation (all p > 0.05). However, global longitudinal PS (GLPS) was lower in groups with CA dilation than those without CA dilation (-12.6 ± 4.1% vs -14.9 ± 2.6%, p < 0.05). For regional strain parameters, the segments with CA dilation (n = 301) were lower than those in both normal controls (n = 416) and segments without CA dilation (n = 547) in regional radial, circumferential and longitudinal PS (all p < 0.05). The severity of CA dilation was positively correlated to GLPS and regional longitudinal PS (r = 0.388 and r = 0.222; both p < 0.05) in KD patients. After adjusting for clinical characteristics, the multivariate analysis demonstrated that Z score was independently associated with GLPS in KD patients (β = 0.469, p = 0.000, model R² = 0.355).

CONCLUSIONS

CMR tissue tracking could sensitively identify subclinical LV dysfunction in KD patients with CA dilation. LV systolic dysfunction occurs particularly in the myocardium dominated by the dilated coronary artery. CA dilation is an independent predictor of LV systolic dysfunction.