Biventricular myocardial strain analysis in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) using cardiovascular magnetic resonance feature tracking

Abstract

BackgroundFibrofatty degeneration of myocardium in ARVC is associated with wall motion abnormalities. The aim of this study was to examine whether Cardiovascular Magnetic Resonance (CMR) based strain analysis using feature tracking (FT) can serve as a quantifiable measure to confirm global and regional ventricular dysfunction in ARVC patients and support the early detection of ARVC.MethodsWe enrolled 20 patients with ARVC, 30 with borderline ARVC and 22 subjects with a positive family history but no clinical signs of a manifest ARVC. 10 healthy volunteers (HV) served as controls. 15 ARVC patients received genotyping for Plakophilin-2 mutation (PKP-2), of which 7 were found to be positive. Cine MR datasets of all subjects were assessed for myocardial strain using FT (TomTec Diogenes Software). Global strain and strain rate in radial, circumferential and longitudinal mode were assessed for the right and left ventricle. In addition strain analysis at a segmental level was performed for the right ventricular free wall.ResultsRV global longitudinal strain rates in ARVC (−0.68 ± 0.36 sec−1) and borderline ARVC (−0.85 ± 0.36 sec−1) were significantly reduced in comparison with HV (−1.38 ± 0.52 sec−1, p ≤ 0.05). Furthermore, in ARVC patients RV global circumferential strain and strain rates at the basal level were significantly reduced compared with HV (strain: −5.1 ± 2.7 vs. -9.2 ± 3.6%; strain rate: −0.31 ± 0.13 sec−1 vs. -0.61 ± 0.21 sec−1). Even for patients with ARVC or borderline ARVC and normal RV ejection fraction (n=30) global longitudinal strain rate proved to be significantly reduced compared with HV (−0.9 ± 0.3 vs. -1.4 ± 0.5 sec−1; p < 0.005). In ARVC patients with PKP-2 mutation there was a clear trend towards a more pronounced impairment in RV global longitudinal strain rate. On ROC analysis RV global longitudinal strain rate and circumferential strain rate at the basal level proved to be the best discriminators between ARVC patients and HV (AUC: 0.9 and 0.92, respectively).ConclusionCMR based strain analysis using FT is an objective and useful measure for quantification of wall motion abnormalities in ARVC. It allows differentiation between manifest or borderline ARVC and HV, even if ejection fraction is still normal.

Progress in the Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia by Cardiac Magnetic Resonance Imaging Using Feature Tracking

“…Strain abnormalities that are most prominent at the base of the right ventricle are consistent with current paradigms of the spectrum of disease of ARVC/D (7) (8). Further, the results of Prati et al using feature tracking is very consistent with the results of other authors (9,10). Thus the work by Prati et al continues to strengthen the argument that feature tracking of the right ventricle will eventually have a role in the diagnosis of ARVC/D using CMR methods.…”

Noninvasive Multimodality Imaging in ARVD/C

“…Although a regional wall motion abnormality is necessary for ARVD/C TFC fulfillment, the normal RV has a nonuniform appearance, and distinguishing normal from abnormal may be a challenge particularly in the setting of RV volume overload or prominent tethering of the RV free wall by the moderator band. CMR tissue tracking, which has been used to quantify regional ventricular function in ARVD/C (63,64), may suggest one solution. We recently presented data on 106 subjects (39 with overt ARVD/C [genotype+, phenotype+], 37 with pre-clinical ARVD/C [genotype+, phenotype−], and 30 controls [genotype−, phenotype−]) who underwent CMR tissue tracking using steady-state free precession imaging (64).…”

Right Ventricular Strain, Torsion, and Dyssynchrony in Healthy Subjects Using 3D Spiral Cine DENSE Magnetic Resonance Imaging

“…Magnetic Resonance Imaging (MRI) can overcome this limitation thanks to excellent tissue contrast as well as its ability to assess complex structures using multi–slice imaging. Traditional cine Steady State Free Precession (SSFP) MRI has been combined with feature tracking techniques to assess RV mechanics [6]–[8]; however, feature tracking techniques traditionally suffer from poor reproducibility, particularly when used to quantify regional strain, twist, and torsion. More advanced techniques such as 3D myocardial tagging have been used to measure bi–ventricular mechanics [9], but the thin wall of the RV makes tracking tag intersection points (on the order of 8 mm) difficult, ultimately leading to a poor estimate of transmural cardiac function.…”