Myocardial strain assessed by feature tracking cardiac magnetic resonance in patients with a variety of cardiovascular diseases \u2013 A comparison with echocardiography

Kasper Pryds,Brian Bridal Løgstrup,Mona Sahlholdt Hansen,Henrik Wiggers,Anders Hostrup Larsen,Rasmus Stilling Tougaard,Roni Ranghøj Nielsen,Nils Henrik Hansson,Hans Erik Bøtker,Anne Yoon Krogh Grøndal,Tor Skibsted Clemmensen,Won Yong Kim

doi:10.1038/s41598-019-47775-4

Abstract

Myocardial deformation assessed by speckle tracking echocardiography (STE) is increasingly used for diagnosis, monitoring and prognosis in patients with clinical and pre-clinical cardiovascular diseases. Feature tracking cardiac magnetic resonance (FT-CMR) also allows myocardial deformation analysis. To clarify whether the two modalities can be used interchangeably, we compared myocardial deformation analysis by FT-CMR with STE in patients with a variety of cardiovascular diseases and healthy subjects. We included 40 patients and 10 healthy subjects undergoing cardiac magnetic resonance and echocardiographic examination for left ventricular volumetric assessment. We studied patients with heart failure and reduced ejection fraction (n = 10), acute perimyocarditis (n = 10), aortic valve stenosis (n = 10), and previous heart transplantation (n = 10) by global longitudinal (GLS), radial (GRS) and circumferential strain (GCS). Myocardial deformation analysis by FT-CMR was feasible in all but one participant. While GLS, GRS and GCS measured by FT-CMR correlated overall with STE (r = 0.74 and p < 0.001, r = 0.58 and p < 0.001, and r = 0.76 and p < 0.001), the correlations were not consistent within subgroups. GLS was systematically lower, whereas GRS and GCS were higher by FT-CMR compared to STE (p = 0.04 and p < 0.0001). Inter- and intra-observer reproducibility were comparable for FT-CMR and STE overall and across subgroups. In conclusion, myocardial deformation can be evaluated using FT-CMR applied to routine cine-CMR images in patients with a variety of cardiovascular diseases. However, correlation between FT-CMR and STE was modest and agreement was not optimal due to systematic bias regarding GLS and GCS. Consequently, FT-CMR and STE should not be used interchangeably for myocardial strain evaluation.

Highlights

Myocardial deformation assessed by speckle tracking echocardiography (STE) is increasingly used for diagnosis, monitoring and prognosis in patients with clinical and pre-clinical cardiovascular diseases
global longitudinal strain (GLS), global radial strain (GRS) and global circumferential strain (GCS) measured by Feature tracking cardiac magnetic resonance (FT-cardiac magnetic resonance (CMR)) correlated with STE (r = 0.74, p < 0.001, r = 0.58, p < 0.001, and r = 0.76, p < 0.001) (Fig. 2 and Table 2)
GLS was systematically lower (12.5 ± 3.1 vs. 15.6 ± 4.3; 95% confidence interval (CI) −3.9 to −2.3, p < 0.0001), whereas GRS (34.8 ± 14.5 vs. 30.6 ± 12.0; 95% CI 0.2 to 8.2, p = 0.04) and GCS (18.3 ± 6.4 vs. 14.2 ± 4.8; 95% CI 2.8 to 5.5, p < 0.0001) were higher by FT-CMR than by STE (Table 2)