Abstract
Left ventricular global longitudinal strain (LVGLS) analysis is a sensitive measurement of myocardial deformation most often done using speckle-tracking transthoracic echocardiography (TTE). We propose a novel approach to measure LVGLS using feature-tracking software on the magnitude dataset of 4D flow cardiovascular magnetic resonance (CMR) and compare it to dynamic computed tomography (CT) and speckle tracking TTE derived measurements. In this prospective cohort study 59 consecutive adult patients with a bicuspid aortic valve (BAV) were included. The study protocol consisted of TTE, CT, and CMR on the same day. Image analysis was done using dedicated feature-tracking (4D flow CMR and CT) and speckle-tracking (TTE) software, on apical 2-, 3-, and 4-chamber long-axis multiplanar reconstructions (4D flow CMR and CT) or standard apical 2-, 3-, and 4-chamber acquisitions (TTE). CMR and CT GLS analysis was feasible in all patients. Good correlations were observed for GLS measured by CMR (− 21 ± 3%) and CT (− 20 ± 3%) versus TTE (− 20 ± 3%, Pearson’s r: 0.67 and 0.65, p < 0.001). CMR also correlated well with CT (Pearson’s r 0.62, p < 0.001). The inter-observer analysis showed moderate to good reproducibility of GLS measurement by CMR, CT and TTE (Pearsons’s r: 0.51, 0.77, 0.70 respectively; p < 0.05). Additionally, ejection fraction (EF), end-diastolic and end-systolic volume measurements (EDV and ESV) correlated well between all modalities (Pearson’s r > 0.61, p < 0.001). Feature-tracking GLS analysis is feasible using the magnitude images acquired with 4D flow CMR. GLS measurement by CMR correlates well with CT and speckle-tracking 2D TTE. GLS analysis on 4D flow CMR allows for an integrative approach, integrating flow and functional data in a single sequence. Not applicable, observational study.
Highlights
For decades left ventricular (LV) ejection fraction (EF) has been the gold standard for quantification of systolic LV function [1]
In this study we propose a novel method that uses this feature-tracking algorithm on magnitude images acquired during 4D flow Cardiovascular Magnetic Resonance (CMR) to quantify LV volumes and global longitudinal strain (GLS). 4D flow CMR allows for comprehensive post-hoc evaluation of blood flow patterns by 3D blood flow visualization and quantification of flow parameters [18]
The aim of this study was to assess the feasibility of left ventricular global longitudinal strain (LVGLS) measurement using magnitude 4D flow Cardiovascular Magnetic Resonance (CMR) and dynamic computed tomography (CT) datasets, and to provide data on the correlation between these novel approaches and the ‘gold standard’ of speckletracking derived GLS values using two-dimensional echocardiography (TTE)
Summary
For decades left ventricular (LV) ejection fraction (EF) has been the gold standard for quantification of systolic LV function [1]. GLS is defined as the percentage of shortening between the end-diastolic and end-systolic length of the myocardium This technique of deformation measurement has been validated in different populations using speckle-tracking echocardiography [5,6,7,8,9,10,11,12,13,14,15]. More recently it was shown that GLS can be derived from multiphase Computed Tomography (CT) datasets and conventional Cardiovascular Magnetic Resonance (CMR) steady state free-precession (SSFP) cine imaging using feature-tracking algorithms [16, 17]. These techniques, especially GLS measurement using CT are still new and not yet very well validated. Strain analysis would be a valuable additional feature of 4D flow CMR, as this would allow for integrative analysis of flow and function in one sequence
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