Effect of comprehensive initial training on the variability of left ventricular measures using fast-SENC cardiac magnetic resonance imaging

Abstract

Cardiac magnetic resonance (CMR) is becoming the imaging modality of choice in multicenter studies where highly reproducible measurements are necessary. The purpose of this study was to assess the effect of comprehensive initial training on reproducibility of quantitative left ventricular (LV) parameters estimated using strain-encoded (SENC) imaging. Thirty participants (10 patients with heart failure (HF) and preserved LV ejection fraction (HFpEF), 10 patients with HF and reduced LV ejection fraction (HFrEF) and 10 healthy volunteers) were examined using fast-SENC imaging. Four observers with different experience in non-invasive cardiac imaging completed comprehensive initial training course and were invited to perform CMR data analysis. To assess agreement between observers, LV volumes, mass, ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS) were estimated using dedicated software (MyoStrain, USA). To test intraobserver agreement data analysis was repeated after 4 weeks. SENC imaging and analysis were fast and were completed in less than 5 minutes. LV end-diastolic volume index (LVEDVi), LVEF and strain were significantly lower in HFpEF patients than in healthy volunteers (p = 0.019 for LVEDVi; p = 0.023 for LVEF; p = 0.004 for GLS and p < 0.001 for GCS). All LV functional parameters were further reduced in HFrEF. Excellent interobserver agreement was found for all LV parameters independently of the level of experience. The reproducibility of LV mass was lower, especially at the intraobserver level (ICC 0.91; 95% CI 0.74–0.96). LV volumetric and functional parameters derived using fast-SENC imaging, are highly reproducible. The appropriate initial training is relevant and allows to achieve highest concordance in fast-SENC measurements.

Value CMR: Towards a Comprehensive, Rapid, Cost-Effective Cardiovascular Magnetic Resonance Imaging

“…A large body of literature showed the value of myocardial strain analysis for early detection of subclinical cardiac dysfunction in different cardiovascular diseases before global heart function is affected or symptoms of cardiovascular diseases are observed (28-30), especially in coronary artery disease (31) and heart failure (32), which would allow for early intervention and better outcomes. Further, besides providing strain measurements, SENC showed the capability of producing reproducible global function measurements that are in close agreement with those obtained from cine images (33-35). Therefore, for further reduction of scan time, more SENC images (a total of 6 SAX and 6 LAX slices) could be acquired to provide volumes and mass measurements in lieu of using cine imaging.…”

A multi-vendor, multi-center study on reproducibility and comparability of fast strain-encoded cardiovascular magnetic resonance imaging

“…Morrisville, North Carolina, USA), after being trained by a representative of the software company and completing a written test, as previously described [20]. Figure 2 demonstrates the process of image analysis, starting with the acquisition of the image on the scanner (1.…”

Value CMR: Towards a Comprehensive, Rapid, Cost-Effective Cardiovascular Magnetic Resonance Imaging

“…A large body of literature showed the value of myocardial strain analysis for early detection of subclinical cardiac dysfunction in different cardiovascular diseases before the global heart function is affected or symptoms of cardiovascular diseases are observed [ 30 – 32 ], especially in coronary artery disease [ 33 ] and heart failure [ 34 ], which would allow for early intervention and better outcomes. Further, besides providing strain measurements, SENC showed the capability of producing reproducible global function measurements that are in close agreement with those obtained from cine images [ 35 – 37 ]. Therefore, for further reduction of scan time, more SENC images (a total of 6 SA and 6 LA slices) could be acquired to provide volumes and mass measurements in lieu of using cine imaging.…”