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Comparative Study
. 2020 Jun 4;22(1):42.
doi: 10.1186/s12968-020-00636-w.

Cardiovascular magnetic resonance feature tracking for characterization of patients with heart failure with preserved ejection fraction: correlation of global longitudinal strain with invasive diastolic functional indices

Haruno Ito  1 , Masaki Ishida  2 , Wakana Makino  1 , Yoshitaka Goto  1 , Yasutaka Ichikawa  1 , Kakuya Kitagawa  1 , Taku Omori  3 , Kaoru Dohi  3 , Masaaki Ito  3 , Hajime Sakuma  1
Affiliations
Comparative Study

Cardiovascular magnetic resonance feature tracking for characterization of patients with heart failure with preserved ejection fraction: correlation of global longitudinal strain with invasive diastolic functional indices

Haruno Ito et al. J Cardiovasc Magn Reson. .

Abstract

Background: Left ventricular (LV) diastolic dysfunction is the main cause of heart failure with preserved ejection fraction (HFpEF), and is characterized by LV stiffness and relaxation. Abnormal LV global longitudinal strain (GLS) is frequently observed l in HFpEF, and was shown to be useful in identifying HFpEF patients at high risk for a cardiovascular event. Cardiovascular magnetic resonance (CMR) feature tracking (CMR-FT) enables the reproducible and non-invasive assessment of global strain from cine CMR images. However, the association between GLS and invasively measured parameters of diastolic function has not been investigated. We sought to determine the prevalence and severity of GLS impairment in patients with HFpEF by using CMR-FT, and to evaluate the correlation between GLS measured by CMR-FT and that measured by invasive diastolic functional indices.

Methods: Eighteen patients with HFpEF and 18 age- and sex-matched healthy control subjects were studied. All subjects underwent cine, pre- and post-contrast T1 mapping and late gadolinium-enhancement CMR. In the HFpEF patients, invasive pressure-volume loops were obtained to evaluate LV diastolic properties. GLS was quantified from cine CMR, and extracellular volume fraction (ECV) was quantified from pre- and post-contrast T1 mapping as a known imaging biomarker for predicting LV stiffness.

Results: GLS was significantly impaired in patients with HFpEF (- 14.8 ± 3.3 vs.-19.5 ± 2.8%, p < 0.001). Thirty nine percent (7/18) of HFpEF patients showed impaired GLS with a cut-off of - 13.9%. Statistically significant difference was found in ECV between HFpEF patients and controls (32.2 ± 3.8% vs. 29.9 ± 2.6%, p = 0.044). In HFpEF patients, the time constant of active LV relaxation (Tau) was strongly correlated with GLS (r = 0.817, p < 0.001), global circumferential strain (GCS) (r = 0.539, p = 0.021) and global radial strain (GRS) (r = - 0.552, p = 0.017). Multiple linear regression analysis revealed GLS as the only independent predictor of altered Tau (beta = 0.817, p < 0.001) among age, LV end-diastolic volume index, LV end-systolic volume index, LV mass index, GCS, GRS and GLS.

Conclusions: CMR-FT is a noninvasive approach that enables identification of the subgroup of HFpEF patients with impaired GLS. CMR LV GLS independently predicts abnormal invasive LV relaxation index Tau measurements in HFpEF patients. These findings suggest that feature-tracking CMR analysis in conjunction with ECV, may enable evaluation of diastolic dysfunction in patients with HFpEF.

Keywords: Cardiovascular magnetic resonance; Extracellular volume fraction; Feature tracking; Global longitudinal strain; Heart failure with preserved ejection fraction.

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Conflict of interest statement

Hajime Sakuma, MD receives departmental research grant support from Daiichi Sankyo Company Limited, FUJIFILM Holdings Corporation, Nihon Medi-Physics Co., Ltd., Bayer AG, Siemens AG, Fuji Pharma Co., Ltd., Guerbet SA, and Eisai Co., Ltd. Masaaki Ito, MD receives departmental research grant support from Bristol-Myers Squibb, MSD K.K., Shionogi & Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited and Daiichi, Sankyo Company Limited. All other authors have no conflicts of interest to declare. No relevant conflicts of interest related to the article are disclosed by the authors.

Figures

Fig. 1
Fig. 1
Subject selection. Of 28 patients with HFpEF who underwent CMR and invasive catheterization, 5 were excluded due to significant CAD on CAG, 1 due to claustrophobia, 2 due to OMI on CMR, and 2 due to HOCM on CMR
Fig. 2
Fig. 2
Differences in LV GLS and LV ECV between HFpEF patients and healthy controls. LV GLS was significantly impaired in HFpEF patients compared with controls (− 15.2 ± 4.0%, − 19.1 ± 1.8%, p = 0.0005) whereas LV ECV was not significantly different between HFpEF patients and controls (32.2 ± 3.7% vs. 29.7 ± 3.9%, p = 0.057)
Fig. 3
Fig. 3
Representative imaging findings in a patient with HFpEF and a healthy control subject. Visual assessment of cine and LGE CMR images shows no abnormal findings in images of an 81-year-old female with HFpEF (a) or a 62-year-old healthy female control (b). LV volume, EF and mass are normal in both subjects (c). However, LV GLS is substantially lower (− 14.6%) and ECV is higher (34.9%) in the patient with HFpEF (d) compared with the control subject (− 23.3 and 31.6%, respectively) (e)
Fig. 4
Fig. 4
The examples of pressure volume loop in HFpEF patients with long Tau (left) and short Tau (right) with corresponding GLS curves. The patients with longer Tau had more impaired GLS
Fig. 5
Fig. 5
Correlation of LV relaxation and GLS. A significant positive correlation was observed between LV relaxation (Tau) and LV GLS (r = 0.817, p < 0.001)
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