Cardiac Magnetic Resonance Feature Tracking Biventricular Two-Dimensional and Three-Dimensional Strains to Evaluate Ventricular Function in Children After Repaired Tetralogy of Fallot as Compared with Healthy Children

Barton

et al. 2020

BMC Med Imaging

Background: The accuracy of 2D and 3D strain analyses was evaluated by comparing strain and cardiac function parameters in Fontan repair patients and normal child volunteers. Methods: We retrospectively enrolled 32 patients with Fontan circulation and 32 child volunteers who had undergone clinical cardiac magnetic resonance (CMR) assessment of the dominant ventricle with a 1.5-Tesla MRI scanner. Global and regional strain (2D and 3D) of the dominant ventricle in both groups was assessed using CMR feature-tracking. Correlations between cardiac function and strain data were assessed using Pearson's correlation coefficient values. The intraclass correlation coefficient (ICC) and coefficient of variation (CoV) were determined to evaluate repeatability and agreement. Results: The 2D GLS showed significant differences between the Fontan repair patients and volunteers (− 16.49 ± 5.00 vs.-19.49 ± 2.03; p = 0.002). The 2D GRS and 2D GCS showed no significant differences between two groups. 2D GRS: 38.96 ± 14.48 vs. 37.46 ± 7.77; 2D GCS: − 17.64 ± 5.00 vs.-16.89 ± 2.96, respectively; p > 0.05). The 3D global radial strain (GRS), global circumferential strain (GCS), and global longitudinal strain (GLS) showed significant differences between the Fontan repair patients and volunteers (3D GRS: 36.35 ± 16.72 vs. 44.96 ± 9.98; 3D GLS: − 8.86 ± 6.84 vs.-13.67 ± 2.44; 3D GCS: − 13.70 ± 7.84 vs.-18.01 ± 1.78; p < 0.05, respectively). The ejection fraction (EF) and 3D GCS were significantly associated (r = − 0.491, p = 0.004). The 3D GCS showed correlations with the indexed end-diastolic volume (EDV) (r = 0.523, p = 0.002) and indexed end-systolic volume (ESV) (r = 0.602, p < 0.001). 3D strain showed good reproducibility, with GCS showing the best inter-observer agreement (ICC = 0.87 and CoV = 5.15), followed by GLS (ICC = 0.84 and CoV = 5.36). Conclusions: 3D GCS is feasible, highly reproducible, and strongly correlated with conventional cardiac function measures. 3D GCS assessments may be useful for monitoring abnormal myocardial motion in patients with Fontan circulation.

Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quantitative comparison of two-dimensional and three-dimensional strain measurement using MRI feature tracking in repair Fontan patients and normal child volunteers

Barton

et al. 2020

BMC Med Imaging

“…been used to analyze ventricular function in CHD, particularly in cases of coarctation of the aorta [18] and repaired transposition of the great arteries [19]. Considering the difficulties in ventricular function assessment in Fontan FSV repair patients due to the complex ventricular geometry, 3D strain analysis by FT may be a more accurate tool than 2D strain analysis [12]. In a study of 100 healthy subjects.…”

Section: Cmr-ft Is a Non-invasive Modality For Evaluating Ventricularmentioning

confidence: 99%

“…However, ventricular function assessment is challenging in post-Fontan FSV patients due to the complex ventricular geometry. Some studies have indicated that three-dimensional (3D) strain analysis may overcome such geometry-dependent limitations of 2D strain analysis by referencing the intrinsic directions of deformation [12,13]. To our knowledge, there are no previous studies assessing three-dimensional strain analysis of SSFP cine images in Fontan patients and normal volunteers [14].…”

Section: Introductionmentioning

confidence: 99%

Quantitative Comparison of Two-dimensional and Three-dimensional Strain Measurement Using MRI Feature Tracking in Repair Fontan Patients and Normal Child Volunteers

Gregory

et al. 2019

Preprint

Purpose The accuracy of 2D and 3D strain analyses was evaluated by comparing strain and cardiac function parameters in Fontan repair patients and normal child volunteers. Methods We retrospectively enrolled 32 patients with Fontan circulation and 32 child volunteers who had undergone clinical cardiac magnetic resonance (CMR) assessment of the dominant ventricle with a 1.5-Tesla MRI scanner. Global and regional strain (2D and 3D) of the dominant ventricle in both groups was assessed using CMR feature-tracking. Correlations between cardiac function and strain data were assessed using Pearson’s correlation coefficient values. The intraclass correlation coefficient (ICC) was determined to evaluate repeatability and agreement. Results: The 3D global radial strain (GRS), global circumferential strain (GCS), and global longitudinal strain (GLS) showed significant differences between the Fontan repair patients and volunteers (3D GRS: 36.35 ± 16.72 vs. 44.96 ± 9.98; 3D GLS: -8.86 ± 6.84 vs. -13.67 ± 2.44; 3D GCS: -13.70 ± 7.84 vs. -18.01 ± 1.78; p < 0.05, respectively). The ejection fraction (EF) and 3D GCS were significantly associated (r = -0.491, p = 0.004). The 3D GCS showed correlations with the indexed end-diastolic volume (EDV) (r = 0.523, p = 0.002) and indexed end-systolic volume (ESV) (r = 0.602, p < 0.001). 3D strain showed good reproducibility, with GCS showing the best inter-observer agreement (ICC, 0.87), followed by GLS (ICC, 0.84) and GRS (ICC, 0.80). Conclusion:3D GCS is feasible, highly reproducible, and strongly correlated with conventional cardiac function measures. 3D GCS assessments may be useful for monitoring abnormal myocardial motion in patients with Fontan circulation. Keywords Strain; Feature tracking; Fontan operation; Pediatric

Right and left ventricular interactions, strain, and remodeling in repaired pulmonary stenosis patients with preserved right ventricular ejection fraction: A cardiac magnetic resonance study

Magnetic Resonance Imaging

Ouyang

et al. 2020

BackgroundRight ventricular dilation and dysfunction is a common long‐term complication in patients with repaired pulmonary stenosis (rPS). Additionally, abnormal right and left ventricular interactions have been reported in right‐sided heart defect after intervention, including in pulmonary stenosis.PurposeTo analyze ventricular strain, remodeling, and left and right ventricular interactions in rPS patients with preserved right ventricular ejection fraction (RVEF) compared with healthy children using cardiac magnetic resonance.Study TypeA cross‐sectional study.PopulationIn all, 34 rPS patients and 10 healthy children volunteers (controls).Field Strength/Sequence3.0T/2D balanced steady‐state free precession (2D b‐SSFP) cine, late gadolinium enhancement (LGE), and 2D phase contrast (2D‐PC).AssessmentPulmonary regurgitation (PR) fractions of the main pulmonary artery, biventricular volumes, masses, function, and cardiac strain.Statistical TestsMann–Whitney U‐test, t‐test, Pearson correlation coefficients, Spearman's correlation coefficients, and intraclass correlation coefficients analysis were performed.ResultsFor group analysis, the right ventricular (RV) global circumferential strain and radial strain were significantly increased in patients when compared with controls (−13.57 ± 2.69 vs. −5.91 ± 3.16, P < 0.001; 25.31 ± 8.12 vs. 9.87 ± 5.32, P < 0.001, respectively). The fraction of PR displayed moderate correlation with right ventricular end‐diastolic volume index (RVEDVi) (r = 0.452, P = 0.022). RVEDVi and mass index were larger in patients vs. control (104.92 ± 27.46 vs. 85.15 ± 11.98, P = 0.016; 18.28 ± 4.95g/m2 vs. 11.67 ± 2.14 g/m2, P < 0.001, respectively). Patients presented with preserved left ventricular ejection function, but was lower than healthy controls (60.89% ± 4.89% vs. 65.95% ± 4.56%, P = 0.006). Regional circumferential strain of segment 3 of left ventricle (LV) were significantly decreased in patients (−7.79 ± 6.52 vs. −13.56 ± 3.22, P = 0.003).Data ConclusionCompensated increased RV strain, myocardial remodeling of RV, and adverse right and left ventricular interactions occur in rPS patients with preserved RVEF. The decreased interventricular septum strain may lead to impaired LV function due to RV dilation as a result of PR.Level of Evidence: 3Technical Efficacy Stage: 3J. Magn. Reson. Imaging 2020;52:129–138.