Abstract
BackgroundAnalysis of left ventricular (LV) mechanical dyssynchrony may provide incremental prognostic information regarding cardiac resynchronization therapy (CRT) response in addition to QRS width alone. Our objective was to quantify LV dyssynchrony using feature tracking post processing of routine cardiovascular magnetic resonance (CMR) cine acquisitions (FT-CMR) in comparison to speckle tracking echocardiography.MethodsWe studied 72 consecutive patients who had both steady-state free precession CMR and echocardiography. Mid-LV short axis CMR cines were analyzed using FT-CMR software and compared with echocardiographic speckle tracking radial dyssynchrony (time difference between the anteroseptal and posterior wall peak strain).ResultsRadial dyssynchrony analysis was possible by FT-CMR in all patients, and in 67 (93%) by echocardiography. Dyssynchrony by FT-CMR and speckle tracking showed limits of agreement of strain delays of ± 84 ms. These were large (up to 100% or more) relative to the small mean delays measured in more synchronous patients, but acceptable (mainly <25%) in those with mean delays of >200 ms. Radial dyssynchrony was significantly greater in wide QRS patients than narrow QRS patients by both FT-CMR (radial strain delay 230 ± 94 vs. 77 ± 92* ms) and speckle tracking (radial strain delay 242 ± 101 vs. 75 ± 88* ms, all *p < 0.001).ConclusionsFT-CMR delivered measurements of radial dyssynchrony from CMR cine acquisitions which, at least for the patients with more marked dyssynchrony, showed reasonable agreement with those from speckle tracking echocardiography. The clinical usefulness of the method, for example in predicting prognosis in CRT patients, remains to be investigated.
Highlights
Analysis of left ventricular (LV) mechanical dyssynchrony may provide incremental prognostic information regarding cardiac resynchronization therapy (CRT) response in addition to QRS width alone
Patient characteristics FT-cardiovascular magnetic resonance (CMR) analysis was possible in all 72 patients, the study group consisted of 67 patients after 5 patients (7%) were eliminated because it was technically not possible to perform speckle tracking analysis on their suboptimal echocardiography images
This study introduced the feasibility of more recent feature tracking CMR software (FTCMR) software to quantify radial dyssynchrony or routine clinical CMR steady state free precession (SSFP) cine images
Summary
Analysis of left ventricular (LV) mechanical dyssynchrony may provide incremental prognostic information regarding cardiac resynchronization therapy (CRT) response in addition to QRS width alone. QRS width and morphology are used as the primary selection criteria for CRT, QRS the finding of baseline mechanical dyssynchrony has important prognostic utility [4,5,6,7] CRT response remains variable with part because of expertise of specific tagging sequences needed, additional scanning time and the potential for complex post-processing analysis. The objective of the present study was to assess the feasibility of utilizing a semi-automated feature tracking CMR software approach applied to routine clinical SSFP imaging to quantify LV radial dyssynchrony in comparison to speckle tracking echocardiography in the same patients
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