Inter-study repeatability of circumferential strain and diastolic strain rate by CMR tagging, feature tracking and tissue tracking in ST-segment elevation myocardial infarction

Abstract

Strain assessment allows accurate evaluation of myocardial function and mechanics in ST-segment elevation myocardial infarction (STEMI). Strain using cardiovascular magnetic resonance (CMR) has traditionally been assessed with tagging but limitations of this technique have led to more widespread use of alternative methods, which may be more robust. We compared the inter-study repeatability of circumferential global peak-systolic strain (Ecc) and peak-early diastolic strain rate (PEDSR) derived by tagging with values obtained using novel cine-based software: Feature Tracking (FT) (TomTec, Germany) and Tissue Tracking (TT) (Circle cvi 42 , Canada) in patients following STEMI. Twenty male patients (mean age 56 ± 10 years, mean infarct size 13.7 ± 7.1% of left ventricular mass) were randomised to undergo CMR 1-5 days post-STEMI at 1.5 T or 3.0 T, repeated after ten minutes at the same field strength. Ecc and PEDSR were assessed using tagging, FT and TT. Inter-study repeatability was evaluated using Bland-Altman analyses, coefficients of variation (CoV) and intraclass correlation coefficient (ICC). Ecc (%) was significantly lower with tagging than with FT or TT at 1.5 T (− 9.5 ± 3.3 vs. − 17.5 ± 3.8 vs. −15.5 ± 5.2, respectively, p < 0.001) and 3.0 T (− 13.1 ± 1.8 vs. − 19.4 ± 2.9 vs. − 17.3 ± 2.1, respectively, p = 0.001). This was similar for PEDSR (.s −1 ): 1.5 T (0.6 ± 0.2 vs. 1.5 ± 0.4 vs. 1.0 ± 0.4, for tagging, FT and TT respectively, p < 0.001) and 3.0 T (0.6 ± 0.2 vs. 1.5 ± 0.3 vs. 0.9 ± 0.3, respectively, p < 0.001). Inter-study repeatability for Ecc at 1.5 T was good for tagging and excellent for FT and TT: CoV 16.7%, 6.38%, and 8.65%, respectively. Repeatability for Ecc at 3.0 T was good for all three techniques: CoV 14.4%, 11.2%, and 13.0%, respectively. However, repeatability of PEDSR was generally lower than that for Ecc at 1.5 T (CoV 15.1%, 13.1%, and 34.0% for tagging, FT and TT, respectively) and 3.0 T (CoV 23.0%, 18.6%, and 26.2%, respectively). Following STEMI, Ecc and PEDSR are higher when measured with FT and TT than with tagging. Inter-study repeatability of Ecc is good for tagging, excellent for FT and TT at 1.5 T, and good for all three methods at 3.0 T. The repeatability of PEDSR is good to moderate at 1.5 T and moderate at 3.0 T. Cine-based methods to assess Ecc following STEMI may be preferable to tagging.

Reproducibility and its confounders of CMR feature tracking myocardial strain analysis in patients with suspected myocarditis

“…While awareness for the clinical significance of this marker is rising, little is known about its reproducibility with CMR-FT. In 20 patients with a myocardial infarction, Nazir et al showed 2D early diastolic strain rate measurements were reproducible by CMR-FT at both 1.5 and 3 T, comparable to MRI tagging [7]. Here we observed for 2D and 3D left ventricular measurements, mostly good to excellent agreement for early diastolic strain rate.…”

“…Specifically, reproducibility of CMR-FT has not been reported for a large cardiovascular cohort. There are some recent publications investigating reliability and agreement in control populations, and in smaller cohorts of cardiovascular patients typically with less than 30 patients [6][7][8][9][10][11][12]. Yet its reproducibility in a larger scale, clinical real-world patient population is still unclear especially for parameters beyond left ventricular (LV) strain 2D peak strain, including diastolic markers, measures in 3D, and the right ventricle, nor is it known which type of clinical features may impact FT analysis.…”

Protective effect of Impella on left ventricular function after acute broad anterior wall ST elevation myocardial infarction with cardiogenic shock: cardiaovascular magnetic resonance imaging strain analysis

“…Myocardial strain (de ned as the change in length of an object relative to its original length) is a sensitive measure of contractility, which can be calculated in a variety of coordinate systems at both the segmental and global level; it is typically determined in the three axes of myocardial contraction (circumferential, longitudinal, and radial). 14 SR measures the change in strain for a given vector as a function of time. Global myocardial circumferential systolic strain and diastolic SR were reported to be objective, sensitive markers of myocardial systolic and diastolic function.…”

The Combination of Feature Tracking and Late Gadolinium Enhancement for Identification Between Hypertrophic Cardiomyopathy and Hypertensive Heart Disease

“…Cardiovascular magnetic resonance feature tracking (CMR-FT) technology allows for high-resolution evaluation of myocardial deformation and the determination of myocardial strain parameters with excellent consistency and reproducibility ( 8 – 10 ). It tracks tissue motion between epicardial and endocardial borders and measures changes of cardiac dimensions throughout the whole cardiac cycle, thus potentially distinguishing the normal and abnormal cardiac functions ( 11 ).…”