Abstract
BackgroundMyocardial strain is an established parameter for the assessment of cardiac function and routinely derived from speckle tracking echocardiography (STE). Novel post-processing tools allow deformation imaging also by 4D cardiac computed tomography angiography (CCT). This retrospective study aims to analyze the reproducibility of CCT strain and compare it to that of STE. MethodsLeft (LV) and right ventricular (RV), and left atrial (LA) ejection fraction (EF), dimensions, global longitudinal (GLS), circumferential (GCS) and radial strain (GRS) were determined by STE and CCT feature tracking in consecutive patients with severe aortic stenosis evaluated for transcatheter aortic valve implantation. Results106 patients (mean age 79.9 ± 7.8, 44.3% females) underwent CCT at a median of 3 days (IQR 0–28 days) after STE. In CCT, strain measures showed good to excellent reproducibility (intra- and inter-reader intraclass correlation coefficient ≥0.75) consistently in the LV, RV and LA. In STE, only LV GLS and LA GLS yielded good reproducibility, whereas LV GCS and LV GRS showed moderate, and RV GLS and free wall longitudinal strain (FWLS) poor reproducibility. Agreement between CCT and STE was strong for LV GLS only, while other strain features displayed moderate (LV GCS, LA GLS) or weak (LV GRS, RV GLS and FWLS) inter-modality correlation. ConclusionLV, RV and LA CCT strain assessments were highly reproducible. While a strong agreement to STE was found for LV GLS, inter-modality correlation was moderate or weak for LV GCS, LV GRS, and RV and LA longitudinal strain, possibly related to poor reproducibility of STE measurements.
Highlights
Endo- and myocardial strain are established determinants in the evaluation of myocardial contractility 1, describing the degree of deformation of cardiac walls within the cardiac cycle.Deformation of a cardiac cavity can occur along its long axis, its perimeter, or by thickening of its wallglobal longitudinal strain (GLS) 3, while results for left ventricular (LV) global circumferential strain (GCS) and global radial strain (GRS) are inconclusive 4-6
Among 310 consecutive patients with severe aortic stenosis referred for the evaluation of transcathether aortic valve implantation (TAVI), patients were included in the present study (Figure 2) of which 91(86%) patients underwent TAVI
Another n=7 patients were referred to surgical aortic valve replacement and n=8 patients were not deemed eligible for TAVI
Summary
Endo- and myocardial strain are established determinants in the evaluation of myocardial contractility 1, describing the degree of deformation of cardiac walls within the cardiac cycle.Deformation of a cardiac cavity can occur along its long axis (global longitudinal strain – GLS), its perimeter (global circumferential strain – GCS), or by thickening of its wall (global radial strain – GRS)GLS 3, while results for LV GCS and GRS are inconclusive 4-6. Speckle-tracking echocardiography (STE) uses unique interference patterns (“speckles”) that are followed across the cardiac cycle to obtain the degree of deformation and derive strain. The introduction of novel post-processing tools enable feature tracking (FT) based strain evaluation by 4D cardiac computed tomography angiography (CCT). Broad evidence that supports the clinical value of this promising tool derived from CCT in a real-world setting is widely lacking. Myocardial strain is an established parameter for the assessment of cardiac function and routinely derived from speckle tracking echocardiography (STE). Novel post-processing tools allow deformation imaging by 4D cardiac computed tomography angiography (CCT).
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