Three-Dimensional Tricuspid Annular Motion Analysis from Cardiac Magnetic Resonance Feature-Tracking

Abstract

Myocardial deformation is a sensitive marker of sub-clinical myocardial dysfunction that carries independent prognostic significance across a broad range of cardiovascular diseases. It is now possible to perform 3D feature tracking of SSFP cines on cardiac magnetic resonance imaging (FT-CMR). This study provides reference ranges for 3D FT-CMR and assesses its reproducibility compared to 2D FT-CMR. One hundred healthy individuals with 10 men and women in each of 5 age deciles from 20 to 70 years, underwent 2D and 3D FT-CMR of left ventricular myocardial strain and strain rate using SSFP cines. Good health was defined by the absence of hypertension, diabetes, obesity, dyslipidaemia, or any cardiovascular, renal, hepatic, haematological and systemic inflammatory disease. Normal values for myocardial strain assessed by 3D FT-CMR were consistently lower compared with 2D FT-CMR measures [global circumferential strain (GCS) 3D − 17.6 ± 2.6% vs. 2D − 20.9 ± 3.7%, P < 0.005]. Validity of 3D FT-CMR was confirmed against other markers of systolic function. The 3D algorithm improved reproducibility compared to 2D, with GCS having the best inter-observer agreement [intra-class correlation (ICC) 0.88], followed by global radial strain (GRS; ICC 0.79) and global longitudinal strain (GLS, ICC 0.74). On linear regression analyses, increasing age was weakly associated with increased GCS (R 2 = 0.15, R = 0.38), peak systolic strain rate, peak late diastolic strain rate, and lower peak early systolic strain rate. 3D FT-CMR offers superior reproducibility compared to 2D FT-CMR, with circumferential strain and strain rates offering excellent intra-and inter-observer variability. Normal range values for myocardial strain measurements using 3D FT-CMR are provided.

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

“…CMR-FT based global and segmental deformation quantification helps early detecting of subclinical myocardial dysfunction, monitoring the progress and predicting the outcome of the disease, such as heart failure with preserved ejection fraction ( Zhong et al, 2013 ). Quantitative assessment of systolic right ventricular myocardial deformation can be used as a more quantitative tool to measure RV function in diseases such as repaired tetralogy of Fallot ( Zhong et al, 2012 ) and pulmonary arterial hypertension ( Leng et al, 2016 ).…”

“…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 ).…”

Current Understanding of the Biomechanics of Ventricular Tissues in Heart Failure

“…Depend on the imaging technique, 3D geometry is reconstructed and the strain and strain rate are then calculated as the indicators of ventricle stiffness. The in vivo 3D strain analyses can be achieved by applying a so-called hyperelastic warping method to various types of medical images such as cine CMR or echocardiography, from which global or regional myocardial strain can be calculated [68][69][70]. The hyperelastic warping method is a deformable image registration technique, which uses a deformable finite element mesh to register the target image to the reference image.…”

Biomechanics of the tricuspid annulus: A review of the annulus' in vivo dynamics with emphasis on ovine data

“…With the advent of 3D US, the resolution of echocardiographic analyses improved markedly which allowed for the first high‐fidelity calculations of annular area and height throughout the cardiac cycle . Similarly to 3D US, MRI has been used to characterize the 3D configuration of the tricuspid annulus . Regardless of imaging technology, the basic approach is identical: points along the annulus are identified in 2D cross‐sections and afterwards compiled into 3D point clouds, thus spatially discretizing the annulus.…”