Comparison of strain imaging techniques in CRT candidates: CMR tagging, CMR feature tracking and speckle tracking echocardiography

Wouter M Van Everdingen,Pierre Croisille,Alwin Zweerink,Robin Nijveldt,Alexander H Maass,Cornelis P Allaart,Odette A E Salden,Bastiaan Geelhoed,Patrick Clarysse,Albert C Van Rossum,Michiel Rienstra,Maarten J Cramer,Marc A Vos,Isabelle C Van Gelder,Mathias Meine,Kevin Vernooy,Frederik J De Lange

doi:10.1007/s10554-017-1253-5

Abstract

Parameters using myocardial strain analysis may predict response to cardiac resynchronization therapy (CRT). As the agreement between currently available strain imaging modalities is unknown, three different modalities were compared. Twenty-seven CRT-candidates, prospectively included in the MARC study, underwent cardiac magnetic resonance (CMR) imaging and echocardiographic examination. Left ventricular (LV) circumferential strain was analysed with CMR tagging (CMR-TAG), CMR feature tracking (CMR-FT), and speckle tracking echocardiography (STE). Basic strain values and parameters of dyssynchrony and discoordination obtained with CMR-FT and STE were compared to CMR-TAG. Agreement of CMR-FT and CMR-TAG was overall fair, while agreement between STE and CMR-TAG was often poor. For both comparisons, agreement on discoordination parameters was highest, followed by dyssynchrony and basic strain parameters. For discoordination parameters, agreement on systolic stretch index was highest, with fair intra-class correlation coefficients (ICC) (CMR-FT: 0.58, STE: 0.55). ICC of septal systolic rebound stretch (SRSsept) was poor (CMR-FT: 0.41, STE: 0.30). Internal stretch factor of septal and lateral wall (ISFsep–lat) showed fair ICC values (CMR-FT: 0.53, STE: 0.46), while the ICC of the total LV (ISFLV) was fair for CMR-FT (0.55) and poor for STE (ICC: 0.32). The CURE index had a fair ICC for both comparisons (CMR-FT: 0.49, STE 0.41). Although comparison of STE to CMR-TAG was limited by methodological differences, agreement between CMR-FT and CMR-TAG was overall higher compared to STE and CMR-TAG. CMR-FT is a potential clinical alternative for CMR-TAG and STE, especially in the detection of discoordination in CRT-candidates.

Highlights

Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure, reduced left ventricular (LV) ejection fraction, and a prolonged QRS caused by a left bundle branch block (LBBB) or nonspecific intraventricular conduction delay [1]
This study aims to compare circumferential strain parameters obtained with cardiac magnetic resonance imaging (CMR)-FT and speckle tracking echocardiography (STE) versus gold-standard CMR tagging (CMR-TAG) in patients eligible for CRT
This applied for intra-class correlation coefficients (ICC) values, Bland–Altman characteristics and the correlation coefficient (R) (Table 3). (1) For CMR-FT aortic valve closure (AVC) strain of the septum was fair (ICC 0.55, R 0.67), while it was poor for STE (ICC 0.23, R 0.47)

Summary

Introduction

Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure, reduced left ventricular (LV) ejection fraction, and a prolonged QRS caused by a left bundle branch block (LBBB) or nonspecific intraventricular conduction delay [1]. Patient selection for CRT may be improved with additional parameters reflecting mechanical dyssynchrony or discoordination obtained with strain analysis on imaging [4,5,6,7]. These parameters reflect the LV mechanical consequences caused by an inhomogeneous electrical activation. Clinical application of CMR-FT and STE is more feasible compared to CMR-TAG, as both techniques are applicable to images obtained during standard clinical imaging protocols [14,15,16] Both techniques (i.e. CMR-FT and STE) lack validation on strain parameters reflecting mechanical dyssynchrony and discoordination. The comparison of indices reflecting mechanical dyssynchrony and discoordination are of specific interest

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Conclusion