Myocardial strain analysis of the right ventricle: comparison of different cardiovascular magnetic resonance and echocardiographic techniques

Abstract

Background Right ventricular (RV) strain is a useful predictor of prognosis in various cardiovascular diseases, including those traditionally believed to impact only the left ventricle. We aimed to determine inter-modality and inter-technique agreement in RV longitudinal strain (LS) measurements between currently available cardiovascular magnetic resonance (CMR) and echocardiographic techniques, as well as their reproducibility and the impact of layer-specific strain measurements. Methods RV-LS was determined in 62 patients using 2D speckle tracking echocardiography (STE, Epsilon) and two CMR techniques: feature tracking (FT) and strain-encoding (SENC), and in 17 healthy subjects using FT and SENC only. Measurements included global and free-wall LS (GLS, FWLS). Inter-technique agreement was assessed using linear regression and Bland-Altman analysis. Reproducibility was quantified using intraclass correlation (ICC) and coefficients of variation (CoV). Results We found similar moderate agreement between both CMR techniques and STE in patients: r = 0.57–0.63 for SENC; r = 0.50–0.62 for FT. The correlation between SENC and STE was better for GLS (r = 0.63) than for FWLS (r = 0.57). Conversely, the correlation between FT and STE was higher for FWLS (r = 0.60–0.62) than GLS (r = 0.50–0.54). FT-midmyocardial strain correlated better with SENC and STE than FT-subendocardial strain. The agreement between SENC and FT was fair (r = 0.36–0.41, bias: − 6.4 to − 10.4%) in the entire study group. All techniques except FT showed excellent reproducibility (ICC: 0.62–0.96, CoV: 0.04–0.30). Conclusions We found only moderate inter-modality agreement with STE in RV-LS for both FT and SENC and poor agreement when comparing between the CMR techniques. Different modalities and techniques should not be used interchangeably to determine and monitor RV strain.

Preload Dependency of 2D Right Ventricle Speckle Tracking Echocardiography Parameters in Healthy Volunteers: A Prospective Pilot Study

“…The results of our study have not been compared with other techniques as CMR especially because CMR and echocardiography techniques are not interchangeable for RV strain evaluation [ 26 ]. Finally, this study involved a limited number of young volunteers, especially males, in a single centre.…”

The Predictive Value of Right Ventricular Longitudinal Strain in Pulmonary Hypertension, Heart Failure, and Valvular Diseases

“…The development of imaging techniques provided detailed insight into RV structure, function and mechanics. Cardiac magnetic resonance and 3D echocardiography significantly improved our knowledge about RV structure and function, but speckle-tracking imaging enabled efficient and prompt echocardiographic assessment of RV mechanics (9).…”

Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias

“…Future studies including a larger cohort of patients may detect differences in these strain measures if they are present. Furthermore, advancements in post-processing software packages or in the temporal resolution of CMR studies may improve the visualisation of the thin-walled RV to generate more reliable strain measurements [ 23 ].…”

“…The normal FT-CMR strain values were similar to those derived from speckle-tracking echocardiography (STE), with a good inter-technique agreement for the LV and a moderate intermodality agreement for the RV. Among the strain parameters derived on the FT-CMR, the LV global circumferential strain showed the smallest interobserver and intraobserver variability [ 22 , 23 , 24 , 25 , 26 ].…”