Feature Tracking Cardiac MRI Reveals Abnormalities in Ventricular Function in Patients With Bicuspid Aortic Valve and Preserved Ejection Fraction

Abstract

Subclinical systolic and diastolic left ventricular (LV) dysfunction has been reported in previous echocardiographic studies on congenital bicuspid aortic valve (BAV). Patients with BAV commonly undergo evaluation with magnetic resonance imaging, and feature-tracking cardiovascular magnetic resonance (CMR-FT) is an emerging technique that assesses myocardial strain using standard cine sequences. This study investigated differences in myocardial strain between patients with BAV with preserved ejection fraction (EF) and controls using CMR-FT. Patients with isolated BAV and preserved EF, who had previously undergone CMR (n = 42; mean age, 41.2 ± 13.9) were compared with controls (n = 19; 36.6 ± 9.8; P = .2). Investigational CMR-FT strain analysis software was used to measure circumferential systolic and diastolic strain values, as well as standard LV volumetric and functional parameters. The majority of patients with BAV had mild or no valve dysfunction, and LV myocardial mass end-diastolic volume indices were similar between groups. Peak diastolic circumferential strain rate was lower in patients with BAV than in controls (0.89 ± 0.27 vs 1.21 ± 0.21 s−1, P = .003). After adjusting for covariates, only myocardial mass index was independently associated with peak circumferential systolic strain and diastolic strain rate. Feature-tracking CMR can identify abnormalities of LV strain in a clinical cohort of asymptomatic patients with BAV with preserved EF. Decreases in circumferential diastolic strain rate in patients with BAV suggest evidence of early diastolic dysfunction.

Left ventricular myocardial deformation assessment in asymptomatic patients with recently diagnosed sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis

“…Besides exact global and regional functional assessment, and imaging of structural changes in the myocardium (granulomas and inflammation), CMR could offer a relatively new technique of myocardial strain evaluation. Myocardial deformation could be affected earlier by slight, incipient pathological changes in the myocardium [ 11 – 16 ].…”

“…On the other hand, CMR is restricted by lower phases, although, it profits from better imaging of the epicardial-myocardial and endocardial-myocardial tissue boundaries. CMR feature tracking (FT) is one of the myocardial deformation imaging techniques that has been tested for several clinical conditions, even in patients with preserved LV EF [ 11 , 17 – 19 ]. Nevertheless, there is very little evidence for CMR-FT in patients with recent sarcoidosis [ 20 ].…”

Left ventricular global longitudinal strain in bicupsid aortic valve patients: head-to-head comparison between computed tomography, 4D flow cardiovascular magnetic resonance and speckle-tracking echocardiography

“…This technique of deformation measurement has been validated in different populations using speckle-tracking echocardiography [5][6][7][8][9][10][11][12][13][14][15]. More recently it was shown that GLS can also be derived from multiphase Computed Tomography (CT) datasets and conventional Cardiovascular Magnetic Resonance (CMR) steady state free-precession (SSFP) cine imaging using feature-tracking algorithms [16,17]. However, these techniques, especially GLS measurement using CT are still new and not yet very well validated.…”

Impaction of Regurgitation Jet on Anterior Mitral Leaflet Causes Diastolic Dysfunction in Patients With Bicuspid Aortic Valve and Mild Insufficiency: A Cardiovascular Magnetic Resonance Study

“…The use of CMR-FT to evaluate LV diastolic impairment has already been performed in asymptomatic patients with BAV and preserved ejection fraction [14], evidencing an alteration in diastolic strain parameters in BAV subjects as compared to control groups [14]. Other studies revealed that CMR-FT myocardial diastolic strain analysis was able to predict adverse outcomes in patients with hypertrophic cardiomyopathy or atherosclerosis [25,26] Finally, the use of 4D Flow imaging technique offered a deeper insight on the hemodynamic consequences on intraventricular ows of different patterns of regurgitation jet.…”

“…The advanced analysis of cardiac bers deformability offered by the Cardiovascular Magnetic Resonance (CMR) feature tracking (CMR-FT) technique enables the accurate and reproducible assessment of early modi cations in both LV systolic and diastolic function [11][12][13]. CMR-FT is a postprocessing technique applied to cine steady-state free precession (cine-SSFP) sequences, which analyzes myocardial longitudinal and circumferential strain parameters throughout all phases of cardiac cycle [14].…”