Cardiovascular magnetic resonance-assessed fast global longitudinal strain parameters add diagnostic and prognostic insights in right ventricular volume and pressure loading disease conditions

J Cardiovasc Magn Reson. 2021 Apr 1;23(1):38. doi: 10.1186/s12968-021-00724-5.

Abstract

Background: Parameters of myocardial deformation may provide improved insights into right ventricular (RV) dysfunction. We quantified RV longitudinal myocardial function using a fast, semi-automated method and investigated its diagnostic and prognostic values in patients with repaired tetralogy of Fallot (rTOF) and pulmonary arterial hypertension (PAH), who respectively exemplify patients with RV volume and pressure overload conditions.

Methods: The study enrolled 150 patients (rTOF, n = 75; PAH, n = 75) and 75 healthy controls. RV parameters of interest were fast global longitudinal strain (GLS) and strain rates during systole (GLSRs), early diastole (GLSRe) and late diastole (GLSRa), obtained by tracking the distance from the medial and lateral tricuspid valve insertions to the RV epicardial apex on cine cardiovascular magnetic resonance (CMR).

Results: The RV fast GLS exhibited good agreement with strain values obtained by conventional feature tracking approach (bias - 4.9%, error limits (± 2·standard deviation) ± 4.3%) with fast GLS achieving greater reproducibility and requiring reduced analysis time. Mean RV fast GLS was reduced in PAH and rTOF groups compared to healthy controls (PAH < rTOF < healthy controls: 15.1 ± 4.9 < 19.3 ± 2.4 < 24.4 ± 3.0%, all P < 0.001 in pairwise comparisons). In rTOF patients, RV fast GLS was significantly associated with metabolic equivalents, peak oxygen consumption (PVO2) and percentage of predicted PVO2 achieved during cardiopulmonary exercise testing. Lower RV fast GLS was associated with subnormal exercise capacity in rTOF (area under the curve (AUC) = 0.822, sensitivity = 72%, specificity = 91%, cut-off = 19.3%). In PAH patients, reduced RV fast GLS was associated with RV decompensated hemodynamics (AUC = 0.717, sensitivity = 75%, specificity = 58%, cut-off = 14.6%) and higher risk of clinical worsening (AUC = 0.808, sensitivity = 79%, specificity = 70 %, cut-off = 16.0%).

Conclusions: Quantitative RV fast strain and strain rate parameters assessed from CMR identify abnormalities of RV function in rTOF and PAH and are predictive of exercise capacity, RV decompensation and clinical risks in these patients. Trial registry Clinicaltrials.gov: NCT03217240.

Keywords: Cardiovascular magnetic resonance; Pressure overload; Right ventricular function; Strain; Volume overload.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Automation
  • Cardiac Surgical Procedures / adverse effects
  • Case-Control Studies
  • Female
  • Humans
  • Image Interpretation, Computer-Assisted*
  • Magnetic Resonance Imaging, Cine*
  • Male
  • Middle Aged
  • Observer Variation
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Pulmonary Arterial Hypertension / complications
  • Pulmonary Arterial Hypertension / diagnostic imaging*
  • Pulmonary Arterial Hypertension / physiopathology
  • Reproducibility of Results
  • Tetralogy of Fallot / diagnostic imaging*
  • Tetralogy of Fallot / physiopathology
  • Tetralogy of Fallot / surgery
  • Ventricular Dysfunction, Right / diagnostic imaging*
  • Ventricular Dysfunction, Right / etiology
  • Ventricular Dysfunction, Right / physiopathology
  • Ventricular Function, Right*
  • Ventricular Pressure*
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT03217240