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Comparative Study
. 2020 Jul 23;22(1):51.
doi: 10.1186/s12968-020-00647-7.

Myocardial strain analysis of the right ventricle: comparison of different cardiovascular magnetic resonance and echocardiographic techniques

Jennifer Erley  1 , Radu Tanacli  1 , Davide Genovese  2 , Natalie Tapaskar  3 , Nina Rashedi  3 , Paulius Bucius  1 , Keigo Kawaji  3   4 , Ilya Karagodin  3 , Roberto M Lang  3 , Sebastian Kelle  1   5   6 , Victor Mor-Avi  7 , Amit R Patel  3
Affiliations
Comparative Study

Myocardial strain analysis of the right ventricle: comparison of different cardiovascular magnetic resonance and echocardiographic techniques

Jennifer Erley et al. J Cardiovasc Magn Reson. .

Abstract

Background: Right ventricular (RV) strain is a useful predictor of prognosis in various cardiovascular diseases, including those traditionally believed to impact only the left ventricle. We aimed to determine inter-modality and inter-technique agreement in RV longitudinal strain (LS) measurements between currently available cardiovascular magnetic resonance (CMR) and echocardiographic techniques, as well as their reproducibility and the impact of layer-specific strain measurements.

Methods: RV-LS was determined in 62 patients using 2D speckle tracking echocardiography (STE, Epsilon) and two CMR techniques: feature tracking (FT) and strain-encoding (SENC), and in 17 healthy subjects using FT and SENC only. Measurements included global and free-wall LS (GLS, FWLS). Inter-technique agreement was assessed using linear regression and Bland-Altman analysis. Reproducibility was quantified using intraclass correlation (ICC) and coefficients of variation (CoV).

Results: We found similar moderate agreement between both CMR techniques and STE in patients: r = 0.57-0.63 for SENC; r = 0.50-0.62 for FT. The correlation between SENC and STE was better for GLS (r = 0.63) than for FWLS (r = 0.57). Conversely, the correlation between FT and STE was higher for FWLS (r = 0.60-0.62) than GLS (r = 0.50-0.54). FT-midmyocardial strain correlated better with SENC and STE than FT-subendocardial strain. The agreement between SENC and FT was fair (r = 0.36-0.41, bias: - 6.4 to - 10.4%) in the entire study group. All techniques except FT showed excellent reproducibility (ICC: 0.62-0.96, CoV: 0.04-0.30).

Conclusions: We found only moderate inter-modality agreement with STE in RV-LS for both FT and SENC and poor agreement when comparing between the CMR techniques. Different modalities and techniques should not be used interchangeably to determine and monitor RV strain.

Keywords: Cardiovascular magnetic resonance; Right-ventricular function; Speckle-tracking echocardiography.

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Conflict of interest statement

The authors declare that they have no competing interests. Investigators have received research support (either funding or software support) for other studies from Myocardial Solutions (JE, SK, KK, ARP), Philips (KK, ARP, RML, SK) and Epsilon (RML). SK is on the Advisory Board for Myocardial Solutions.

Figures

Fig. 1
Fig. 1
Representative speckle tracking echocardiography (STE)-image, strain curves and end-systolic strain values of a patient with pulmonary artery hypertension and right-sided heart failure (LVEF:56%, RVEF:28%). LVEF, left ventricular ejection fraction; RVEF, right ventricular ejection fraction. GLS = global longitudinal strain, FWLS = free wall longitudinal strain
Fig. 2
Fig. 2
Representative feature tracking (FT)-images, demonstrating the two contouring approaches to determine subendocardial (Endo-FT) and midmyocardial (Myo-FT) strain, as well as the corresponding strain curves and end-systolic strain values for the same patient with pulmonary artery hypertension and right-sided heart failure
Fig. 3
Fig. 3
Representative strain encoding (SENC)-image, strain curve and end-systolic strain value of the same patient with pulmonary artery hypertension and right-sided heart failure. The color-coded images represent the myocardial contraction. GLS, global longitudinal strain
Fig. 4
Fig. 4
Box-plot diagrams illustrating the distribution of strain values, determined using STE, FT and SENC in 57 patients. Ns, not significant; * = p < 0.05; *** = p < 0.001
Fig. 5
Fig. 5
Box-plot diagrams illustrating the distribution of strain values, determined using FT and SENC in the reference group of 17 healthy subjects. * = p < 0.05, *** = p < 0.001
See this image and copyright information in PMC

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