Quantification of biventricular myocardial function using cardiac magnetic resonance feature tracking, endocardial border delineation and echocardiographic speckle tracking in patients with repaired tetralogy of fallot and healthy controls

Abstract

Background Parameters of myocardial deformation have been suggested to be superior to conventional measures of ventricular function in patients with tetralogy of Fallot (ToF), but have required non-routine, tagged cardiovascular magnetic resonance (CMR) techniques. We assessed biventricular myocardial function using CMR cine-based feature tracking (FT) and compared it to speckle tracking echocardiography (STE) and to simple endocardial border delineation (EBD). In addition, the relation between parameters of myocardial deformation and clinical parameters was assessed. Methods Overall, 28 consecutive adult patients with repaired ToF (age 40.4 ± 13.3 years) underwent standard steady-state-free precession sequence CMR, echocardiography, and cardiopulmonary exercise testing. In addition, 25 healthy subjects served as controls. Myocardial deformation was assessed by CMR based FT (TomTec Diogenes software), CMR based EBD (using custom written software) and STE (TomTec Cardiac Performance Analysis software). Results Feature tracking was feasible in all subjects. A close agreement was found between measures of global left (LV) and right ventricular (RV) global strain. Interobserver agreement for FT and STE was similar for longitudinal LV global strain, but FT showed better inter-observer reproducibility than STE for circumferential or radial LV and longitudinal RV global strain. Reproducibility of regional strain on FT was, however, poor. The relative systolic length change of the endocardial border measured by EBD yielded similar results to FT global strain. Clinically, biventricular longitudinal strain on FT was reduced compared to controls (P < 0.0001) and was related to the number of previous cardiac operations. In addition, FT derived RV strain was related to exercise capacity and VE/VCO 2 -slope. Conclusions Although neither the inter-study reproducibility nor accuracy of FT software were investigated, and its inter-observer reproducibility for regional strain calculation was poor, its calculations of global systolic strain showed similar or better inter-oberver reproducibility than those by STE, and could be applied across RV image regions inaccessible to echo. ‘Global strain’ calculated by EBD gave similar results to FT. Measurements made using FT related to exercise tolerance in ToF patients suggesting that the approach could have clinical relevance and deserves further study.

Multi-Ethnic Study of Atherosclerosis: Association between Left Atrial Function Using Tissue Tracking from Cine MR Imaging and Myocardial Fibrosis

“…It has been suggested that the measurement of LV strain by using tissue tracking with cine cardiac MR imaging was as useful as tagged MR imaging and speckle tracking echocardiography (28,30,31). The interobserver reproducibility for tissue tracking was similar to echocardiography in the measurement of longitudinal LV global strain (28). In our study, we obtained good inter-and intraobserver agreement for LA strain analysis with this method of tissue tracking.…”

“…The measurement of LV and right ventricular strain by using cine cardiac MR has been reported in a few previous studies (28,29). It has been suggested that the measurement of LV strain by using tissue tracking with cine cardiac MR imaging was as useful as tagged MR imaging and speckle tracking echocardiography (28,30,31). The interobserver reproducibility for tissue tracking was similar to echocardiography in the measurement of longitudinal LV global strain (28).…”

“…In addition, tissue tracking has no limitation in the assessment of diastolic relaxation when compared with tagged MR imaging, in which tags fade during the late diastolic phase because of T1 relaxation, which impairs the assessment of myocardial deformation during the atrial contraction and relaxation periods. The measurement of LV and right ventricular strain by using cine cardiac MR has been reported in a few previous studies (28,29). It has been suggested that the measurement of LV strain by using tissue tracking with cine cardiac MR imaging was as useful as tagged MR imaging and speckle tracking echocardiography (28,30,31).…”

Cardiovascular Magnetic Resonance Myocardial Feature Tracking

“…There was also a good agreement between the RV GLS measurements on FT and STE. 46 The inter-and intraobserver agreements were comparable for LV GLS by CMR-FT and STE. For LV GCS and especially GRS, the agreements on FT were better compared with STE.…”

“…45 The precise reason for this difference is unknown at the present time. Among CHD, CMR-FT has been applied for the study of ventricular function in tetralogy of Fallot (TOF), 46 coarctation of the aorta, 47 and in forms of single ventricle ( Figure 5). 48 Harrild et al 49 used CMR-FT to quantify indices of RV and LV strain and synchrony before and a median of 6 months after transcatheter pulmonary valve implantation in patients with dysfunctional right ventricular outflow tract conduits (18 patients with repaired TOF).…”