Abstract
ObjectiveDevelop an accelerated cine displacement encoding with stimulated echoes (DENSE) cardiovascular magnetic resonance (CMR) sequence to enable clinically feasible myocardial strain evaluation in patients with dilated cardiomyopathy (DCM).Materials and methodsA spiral cine DENSE sequence was modified by limiting the field of view in two dimensions using in-plane slice-selective pulses in the stimulated echo. This reduced breath hold duration from 20RR to 14RR intervals. Following phantom and pilot studies, the feasibility of the sequence to assess peak radial, circumferential, and longitudinal strain was tested in control subjects (n = 18) and then applied in DCM patients (n = 29).ResultsDENSE acquisition was possible in all participants. Elements of the data were not analysable in 1 control (6%) and 4 DCM r(14%) subjects due to off-resonance or susceptibility artefacts and low signal-to-noise ratio. Peak radial, circumferential, short-axis contour strain and longitudinal strain was reduced in DCM patients (p < 0.001 vs. controls) and strain measurements correlated with left ventricular ejection fraction (with circumferential strain r = − 0.79, p < 0.0001; with vertical long-axis strain r = − 0.76, p < 0.0001). All strain measurements had good inter-observer agreement (ICC > 0.80), except peak radial strain.DiscussionWe demonstrate the feasibility of CMR strain assessment in healthy controls and DCM patients using an accelerated cine DENSE technique. This may facilitate integration of strain assessment into routine CMR studies.
Highlights
In cardiomyopathy patients, early disease detection and sensitive markers of disease progression are important
We present the results of a feasibility study evaluating the cardiovascular magnetic resonance (CMR) acquisition and analysis of myocardial strain using a novel cine displacement encoding with stimulated echoes (DENSE) sequence, first in healthy control participants and applied to a cohort of dilated cardiomyopathy (DCM) patients
The magnitude image signal-to-noise ratio (SNR) is reduced by 7% when using the stimulated echo field of view (FOV) reduction method (270 ± 120 vs. 290 ± 100, for 20RR interval acquisition with and without the reduced stimulated echo FOV, respectively)
Summary
Early disease detection and sensitive markers of disease progression are important. Left ventricular ejection fraction (LVEF) is the mainstay to assess myocardial function, but has a number of limitations [1]. It is relatively insensitive and compensatory changes in global circumferential strain as well as in wall thickening can mask important disease [2]. Assessment of myocardial strain complements assessment of myocardial function. It affords the opportunity for more sensitive detection of disease and overcomes some of the limitations of myocardial geometry.
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