Imaging 4D morphology and dynamics of mitral annulus in humans using cardiac cine MR feature tracking

Journal of Cardiovascular Magnetic Resonance

et al. 2018

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BackgroundAbnormal left atrial (LA) function is a marker of cardiac dysfunction and adverse cardiovascular outcome, but is difficult to assess, and hence not, routinely quantified. We aimed to determine the feasibility and effectiveness of a fast method to measure long-axis LA strain and strain rate (SR) with standard cardiovascular magnetic resonance (CMR) compared to conventional feature tracking (FT) derived longitudinal strain.MethodsWe studied 50 normal controls, 30 patients with hypertrophic cardiomyopathy, and 100 heart failure (HF) patients, including 40 with reduced ejection fraction (HFrEF), 30 mid-range ejection fraction (HFmrEF) and 30 preserved ejection fraction (HFpEF). LA longitudinal strain and SR parameters were derived by tracking the distance between the left atrioventricular junction and a user-defined point at the mid posterior LA wall on standard cine CMR two- and four-chamber views. LA performance was analyzed at three distinct cardiac phases: reservoir function (reservoir strain εs and strain rate SRs), conduit function (conduit strain εe and strain rate SRe) and booster pump function (booster strain εa and strain rate SRa).ResultsThere was good agreement between LA longitudinal strain and SR assessed using the fast and conventional FT-CMR approaches (r = 0.89 to 0.99, p < 0.001). The fast strain and SRs showed a better intra- and inter-observer reproducibility and a 55% reduction in evaluation time (85 ± 10 vs. 190 ± 12 s, p < 0.001) compared to FT-CMR. Fast LA measurements in normal controls were 35.3 ± 5.2% for εs, 18.1 ± 4.3% for εe, 17.2 ± 3.5% for εa, and 1.8 ± 0.4, − 2.0 ± 0.5, − 2.3 ± 0.6 s− 1 for the respective phasic SRs. Significantly reduced LA strains and SRs were observed in all patient groups compared to normal controls. Patients with HFpEF and HFmrEF had significantly smaller εs, SRs, εe and SRe than hypertrophic cardiomyopathy, and HFmrEF had significantly impaired LA reservoir and booster function compared to HFpEF. The fast LA strains and SRs were similar to FT-CMR for discriminating patients from controls (area under the curve (AUC) = 0.79 to 0.96 vs. 0.76 to 0.93, p = NS).ConclusionsNovel quantitative LA strain and SR derived from conventional cine CMR images are fast assessable parameters for LA phasic function analysis.Electronic supplementary materialThe online version of this article (10.1186/s12968-018-0496-1) contains supplementary material, which is available to authorized users.

Section: Methodsmentioning

confidence: 99%

Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging

Leng

Tan

Journal of Cardiovascular Magnetic Resonance

et al. 2018

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“…Advantages of these techniques include excellent scan-rescan reproducibility, less dependence on operator technique, and more accurate and reproducible measures of the left and right ventricles. Consequently, CMR has become the standard reference modality for measurement of ventricular volume and function ( Bellenger et al, 2000 ), and arguably the optimal imaging modality for quantification of myocardial displacement ( Leng et al, 2015 , 2016 , 2018 ), strain and strain rate ( Rahman et al, 2017 ; Scatteia et al, 2017 ; Koh et al, 2018 ; Zhao et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Normal Values of Myocardial Deformation Assessed by Cardiovascular Magnetic Resonance Feature Tracking in a Healthy Chinese Population: A Multicenter Study

Peng

et al. 2018

Front. Physiol.

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Reference values on atrial and ventricular strain from cardiovascular magnetic resonance (CMR) are essential in identifying patients with impaired atrial and ventricular function. However, reference values have not been established for Chinese subjects. One hundred and fifty healthy volunteers (75 Males/75 Females; 18–82 years) were recruited. All underwent CMR scans with images acceptable for further strain analysis. Subjects were stratified by age: Group 1, 18–44 years; Group 2, 45–59 years; Group 3, ≥60 years. Feature tracking of CMR cine imaging was used to obtain left atrial global longitudinal (LA Ell) and circumferential strains (LA Ecc) and respective systolic strain rates, left ventricular longitudinal (LV Ell), circumferential (LV Ecc) and radial strains (LV Err) and their respective strain rates, and right ventricular longitudinal strain (RV Ell) and strain rate. LA Ell and LA Ecc were 32.8 ± 9.2% and 40.3 ± 13.4%, respectively, and RV Ell was −29.3 ± 6.0%. LV Ell, LV Ecc and LV Err were −22.4 ± 2.9%, −24.3 ± 3.1%, and 79.0 ± 19.4%, respectively. LV Ell and LV Ecc were higher in females than males (P < 0.05). LA Ell, LA Ecc, and LV Ecc decreased, while LV Err increased with age (P < 0.05). LV Ell and RV Ell were not shown to be associated with age. Normal ranges for atrial and ventricular strain and strain rates are provided using CMR feature tracking in Chinese subjects.

“…Lastly, we used 6 points in the routine long-axis views for AVJ reconstruction. By using the 3 routine slices, our prior study reported mean differences of −0.7 ± 0.6 cm 2 and −5.8 ± 4.7 mm for mitral annular 3D area and perimeter, respectively, in comparison to reference values obtained from a series of radially rotational long-axis cine CMR [ 10 ]. This study showed the importance of mitral annular plane motion in cardiac mechanics.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiovascular magnetic resonance (CMR) imaging has emerged as a new way of quantifying long-axis function of the atrioventricular junction (AVJ) with good reproducibility [ [1] , [2] , [3] , [4] , [5] , [6] , [7] ]. Advantages of CMR over conventional tissue Doppler imaging (TDI) include absence of angle dependency [ 8 ], and higher robustness to mask (similar to sample volume in TDI) size and location [ 9 , 10 ]. The CMR-derived parameters of annular systolic velocity (Sm), early diastolic velocity (Em), late diastolic velocity (Am), and mitral annular plane systolic excursion (MAPSE) have great potential for routine use in clinical CMR for assessing left ventricular (LV) function.…”

Section: Introductionmentioning

confidence: 99%

Age-related changes in four-dimensional CMR-derived atrioventricular junction velocities and displacements: Implications for the identification of altered annular dynamics for ventricular function assessment

Leng

IJC Heart & Vasculature

Koh

et al. 2019

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BackgroundWe determined the age-related changes in atrioventricular junction (AVJ) velocities and displacements by feature tracking cardiovascular magnetic resonance (FT-CMR) in a healthy community-based population. We also investigated the importance of age-matching for the identification of altered AVJ dynamics.MethodsFT-CMR was performed in 230 controls (18–78 years) and in two patient groups each consisting of 40 subjects (group 1: 23–55 years, group 2: 56–80 years). AVJ dynamic parameters, including systolic velocity Sm, early diastolic velocity Em, late diastolic velocity Am, maximal systolic excursion MAPSE and the new parameter sweep surface area velocity SSAV were measured.ResultsIncreasing age in the control group was significantly associated with reductions in Sm, Em, MAPSE (r = −0.40, −0.76, −0.34, all P < 0.001) and an increase in Am (r = 0.45, P < 0.001). For patient group 1, the selection of an age-unmatched control group (56–76 years) underestimated the number of patients with abnormal AVJ dynamics during systole and early diastole (38% vs. 70% for Sm; 20% vs. 60% for Em; 35% vs. 50% for MAPSE). In contrast, for patient group 2, the number of patients with systolic and early diastolic AVJ dynamic abnormalities was overestimated (88% vs. 63% for Sm; 90% vs. 68% for Em; 73% vs. 58% for MAPSE) when compared with age-unmatched controls (24–55 years). Fifty-percent (20/40) of the sub-group of patients with normal left ventricular ejection fraction exhibited abnormal systolic Sm or MAPSE measurements.ConclusionsSignificant correlations exist between age and AVJ dynamics. Age matching is important for evaluating AVJ long-axis function.