Abstract
Cardiac magnetic resonance (CMR) is becoming the imaging modality of choice in multicenter studies where highly reproducible measurements are necessary. The purpose of this study was to assess the effect of comprehensive initial training on reproducibility of quantitative left ventricular (LV) parameters estimated using strain-encoded (SENC) imaging. Thirty participants (10 patients with heart failure (HF) and preserved LV ejection fraction (HFpEF), 10 patients with HF and reduced LV ejection fraction (HFrEF) and 10 healthy volunteers) were examined using fast-SENC imaging. Four observers with different experience in non-invasive cardiac imaging completed comprehensive initial training course and were invited to perform CMR data analysis. To assess agreement between observers, LV volumes, mass, ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS) were estimated using dedicated software (MyoStrain, USA). To test intraobserver agreement data analysis was repeated after 4 weeks. SENC imaging and analysis were fast and were completed in less than 5 minutes. LV end-diastolic volume index (LVEDVi), LVEF and strain were significantly lower in HFpEF patients than in healthy volunteers (p = 0.019 for LVEDVi; p = 0.023 for LVEF; p = 0.004 for GLS and p < 0.001 for GCS). All LV functional parameters were further reduced in HFrEF. Excellent interobserver agreement was found for all LV parameters independently of the level of experience. The reproducibility of LV mass was lower, especially at the intraobserver level (ICC 0.91; 95% CI 0.74–0.96). LV volumetric and functional parameters derived using fast-SENC imaging, are highly reproducible. The appropriate initial training is relevant and allows to achieve highest concordance in fast-SENC measurements.
Highlights
In addition to clinical signs and symptoms, a detailed assessment of structural and functional cardiac parameters is considered to be essential and provides important diagnostic information in patients with heart failure (HF)[1,2]
Strain-encoded magnetic resonance (SENC) imaging and analysis was fast with a 15 second scan time and a 3 to 5 minute post-processing time for complete quantitative assessment including left ventricular (LV) volumes, mass, ejection fraction and global longitudinal and circumferential strain
There was no significant difference in LV end-systolic volumes (LVESV) and LV mass (LVM) indices between healthy volunteers and HFpEF patients (p = 0.579 for LVESVi and p = 0.315 for LVMi), while LV end-diastolic volume index (LVEDVi), left ventricular ejection fraction (LVEF) and strain values were significantly lower in HFpEF (87.80 ± 7.65 ml/m2 vs. 75.20 ± 11.66 ml/m2, p = 0.019 for LVEDVi; 60.41 ± 5.57% vs. 55.96 ± 3.40%, p = 0.023 for LVEF; −20.45 ± 1.46% vs. −18.92 ± 0.84%, p = 0.004 for global longitudinal strain (GLS) and −21.25 ± 1.19% vs. −17.35 ± 1.89%, p < 0.001 for global circumferential strain (GCS))
Summary
In addition to clinical signs and symptoms, a detailed assessment of structural and functional cardiac parameters is considered to be essential and provides important diagnostic information in patients with heart failure (HF)[1,2]. Because of its excellent endocardial border definition, cine CMR imaging is the accepted gold standard for quantification of ventricular volumes, mass and ejection fraction[5,6]. In line with other tissue tracking techniques, SENC provides quantitative information about myocardial mechanics and has been validated and applied in multiple experimental and clinical settings[14,15,16]. Recent achievements in fast-SENC data analysis tools have enabled quantification of conventional left ventricular (LV) volumetric and functional parameters with excellent accuracy and minimal educational efforts[18]. We set up this study to investigate the effect of comprehensive initial training on reproducibility of LV volumes, mass, ejection fraction and strain derived using fast-SENC imaging. The main hypothesis was that appropriate initial training has an important impact in terms of cardiac imaging of the readers on the concordance of measurements
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