Abstract
Heart failure (HF) imposes a major global health care burden on society and suffering on the individual. About 50% of HF patients have preserved ejection fraction (HFpEF). More intricate and comprehensive measurement-focused imaging of multiple strain components may aid in the diagnosis and elucidation of this disease. Here, we describe the development of a semi-automated hyperelastic warping method for rapid comprehensive assessment of biventricular circumferential, longitudinal, and radial strains that is physiological meaningful and reproducible. We recruited and performed cardiac magnetic resonance (CMR) imaging on 30 subjects [10 HFpEF, 10 HF with reduced ejection fraction patients (HFrEF) and 10 healthy controls]. In each subject, a three-dimensional heart model including left ventricle (LV), right ventricle (RV), and septum was reconstructed from CMR images. The hyperelastic warping method was used to reference the segmented model with the target images and biventricular circumferential, longitudinal, and radial strain–time curves were obtained. The peak systolic strains are then measured and analyzed in this study. Intra- and inter-observer reproducibility of the biventricular peak systolic strains was excellent with all ICCs > 0.92. LV peak systolic circumferential, longitudinal, and radial strain, respectively, exhibited a progressive decrease in magnitude from healthy control→HFpEF→HFrEF: control (-15.5 ± 1.90, -15.6 ± 2.06, 41.4 ± 12.2%); HFpEF (-9.37 ± 3.23, -11.3 ± 1.76, 22.8 ± 13.1%); HFrEF (-4.75 ± 2.74, -7.55 ± 1.75, 10.8 ± 4.61%). A similar progressive decrease in magnitude was observed for RV peak systolic circumferential, longitudinal and radial strain: control (-9.91 ± 2.25, -14.5 ± 2.63, 26.8 ± 7.16%); HFpEF (-7.38 ± 3.17, -12.0 ± 2.45, 21.5 ± 10.0%); HFrEF (-5.92 ± 3.13, -8.63 ± 2.79, 15.2 ± 6.33%). Furthermore, septum peak systolic circumferential, longitudinal, and radial strain magnitude decreased gradually from healthy control to HFrEF: control (-7.11 ± 1.81, 16.3 ± 3.23, 18.5 ± 8.64%); HFpEF (-6.11 ± 3.98, -13.4 ± 3.02, 12.5 ± 6.38%); HFrEF (-1.42 ± 1.36, -8.99 ± 2.96, 3.35 ± 2.95%). The ROC analysis indicated LV peak systolic circumferential strain to be the most sensitive marker for differentiating HFpEF from healthy controls. Our results suggest that the hyperelastic warping method with the CMR-derived strains may reveal subtle impairment in HF biventricular mechanics, in particular despite a “normal” ventricular ejection fraction in HFpEF.
Highlights
Heart failure (HF) with preserved ejection fraction is a clinical syndrome in which patients have symptoms and signs of HF but normal or near-normal left ventricle ejection fraction (LVEF)
Our results suggest that the hyperelastic warping method with the cardiac magnetic resonance (CMR)-derived strains may reveal subtle impairment in HF biventricular mechanics, in particular despite a “normal” ventricular ejection fraction in heart failure with preserved ejection fraction (HFpEF)
Between the HF groups, LVEF was larger in HFpEF patients (53 ± 7%) than the HF with reduced ejection fraction patients (HFrEF)
Summary
Heart failure (HF) with preserved ejection fraction is a clinical syndrome in which patients have symptoms and signs of HF but normal or near-normal left ventricle ejection fraction (LVEF). 30–50% of patients worldwide with HF have HFpEF (Hogg et al, 2004), including Singapore (Zhong et al, 2013), and the prevalence appears to be rising. Based on large community and admission cohorts, some studies have suggested recently that the prognosis may not differ significantly between HFrEF and HFpEF patients, making HFpEF a substantially challenging public health issue with an increasing burden on the elderly population (Lo et al, 2013). Despite normal or nearly normal LVEF, ventricular contractility indexes used in both Western and Asian population indicate that systolic dysfunction is common in HFpEF patients (Borlaug et al, 2009; Zhong et al, 2011, 2013). Impaired LV systolic function may be revealed by measuring ventricular strain (Lo et al, 2013; Choudhary et al, 2016; Genet et al, 2016a)
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