A Novel Method for Estimating Myocardial Strain: Assessment of Deformation Tracking Against Reference Magnetic Resonance Methods in Healthy Volunteers

Mangion, Kenneth; Gao, Hao; McComb, Christie; Carrick, David; Clerfond, Guillaume; Zhong, Xiaodong; Luo, Xiaoyu; Haig, Caroline; Berry, Colin

doi:10.1038/srep38774

Cited by 25 publications

(21 citation statements)

References 36 publications

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“…The modelling results are in reasonable quantitative agreement with in vivo measurements and clinical observations. For example, the peak aortic flow rate is 468 mL/s, close to the measured peak value (498 mL/s); the ejection duration is 243 ms, and the measured value is around 300 ms; the peak LV pressure is 162 mmHg, comparable to the cuff-measured peak blood pressure 150 mmHg; the average LV systolic strain is around -0.16, which also lies in the normal range of healthy subjects [46].…”

Section: Discussionsupporting

confidence: 74%

A coupled mitral valve—left ventricle model with fluid–structure interaction

Gao

Feng

et al. 2017

Medical Engineering & Physics

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Understanding the interaction between the valves and walls of the heart is important in assessing and subsequently treating heart dysfunction. This study presents an integrated model of the mitral valve (MV) coupled to the left ventricle (LV), with the geometry derived from in vivo clinical magnetic resonance images. Numerical simulations using this coupled MV-LV model are developed using an immersed boundary/finite element method. The model incorporates detailed valvular features, left ventricular contraction, nonlinear soft tissue mechanics, and fluid-mediated interactions between the MV and LV wall. We use the model to simulate cardiac function from diastole to systole. Numerically predicted LV pump function agrees well with in vivo data of the imaged healthy volunteer, including the peak aortic flow rate, the systolic ejection duration, and the LV ejection fraction. In vivo MV dynamics are qualitatively captured. We further demonstrate that the diastolic filling pressure increases significantly with impaired myocardial active relaxation to maintain a normal cardiac output. This is consistent with clinical observations. The coupled model has the potential to advance our fundamental knowledge of mechanisms underlying MV-LV interaction, and help in risk stratification and optimisation of therapies for heart diseases.

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Section: Discussionsupporting

confidence: 74%

A coupled mitral valve—left ventricle model with fluid–structure interaction

Gao

Feng

et al. 2017

Medical Engineering & Physics

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“…However, while feature tracking has provided many insights into myocardial function, it is hindered by the limited number of CMR visible features within the myocardium and errors may be introduced via through-plane motion [ 26 ]. DENSE has been shown to be more reproducible than feature tracking [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

The feasibility of a novel limited field of view spiral cine DENSE sequence to assess myocardial strain in dilated cardiomyopathy

Tayal

Wage

Ferreira

et al. 2019

Magn Reson Mater Phy

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Objective Develop 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 methods A 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). Results DENSE 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. Discussion We 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. Electronic supplementary material The online version of this article (10.1007/s10334-019-00735-5) contains supplementary material, which is available to authorized users.

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“…The additional term

leads to the Green–Lagrange strain having a lower peak value in the shortening (circumferential and longitudinal) directions and a larger peak value in the lengthening (radial) direction during systole. The disparity in strain estimated from feature tracking technique and deformable registration method was also discussed previously ( Mangion et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Quantification of Biventricular Strains in Heart Failure With Preserved Ejection Fraction Patient Using Hyperelastic Warping Method

et al. 2018

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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.

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A Novel Method for Estimating Myocardial Strain: Assessment of Deformation Tracking Against Reference Magnetic Resonance Methods in Healthy Volunteers

Cited by 25 publications

References 36 publications

A coupled mitral valve—left ventricle model with fluid–structure interaction

A coupled mitral valve—left ventricle model with fluid–structure interaction

The feasibility of a novel limited field of view spiral cine DENSE sequence to assess myocardial strain in dilated cardiomyopathy

Quantification of Biventricular Strains in Heart Failure With Preserved Ejection Fraction Patient Using Hyperelastic Warping Method

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