Characterization and clinical significance of right ventricular mechanics in pulmonary hypertension evaluated with cardiovascular magnetic resonance feature tracking

Abstract

BackgroundPrognosis in pulmonary hypertension (PH) is related to right ventricular (RV) function. Quantification of RV mechanics may offer additive value. The objective of our study is to determine the feasibility and clinical and prognostic value of RV strain analysis by cardiovascular magnetic resonance (CMR) based feature tracking (FT) in PH.MethodsWe retrospectively enrolled 116 patients (age 52.2 ± 12 years, 73.6 % women) referred to CMR for PH evaluation who underwent right heart catheterization within 1 month. Using dedicated FT software, peak global longitudinal and circumferential RV strain and strain rates (GLS, GCS, GLSR, and GCSR, respectively) were quantified from standard cine images. Using multivariate regression analysis, we evaluated the associations of strain with a composite endpoint of death, lung transplantation, or functional class deterioration.ResultsRV strain analysis was feasible in 110 (95 %) patients. Patients were classified into: Group A (no PH, normal right ventricular ejection fraction [RVEF]; n = 17), Group B (PH, normal RVEF; n = 26), or Group C (PH, abnormal RVEF; n = 67). All strain and strain rate values were reduced in Group C. Furthermore, GCSR was significantly reduced in Group B (-0.92 [-1.0/-0.7]; p < 0.001) compared to Group A (-1.12 [-1.3/-0.9]; p < 0.001). After adjustment for six clinically meaningful covariates, GLS (hazard ratio 1.06; p = 0.026), GLSR (hazard ratio 2.52; p = 0.04), and GCSR (hazard ratio 4.5; p = 0.01) were independently associated with the composite endpoint. GCSR successfully discriminated patients with and without events (p = 0.01).ConclusionsQuantification of RV strain with CMR-FT is feasible in the majority of patients, correlates with disease severity, and is independently associated with poor outcomes in PH.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-016-0258-x) contains supplementary material, which is available to authorized users.

Relationship between right atrium area and right ventricular ejection fraction on magnetic resonance imaging: comparison with other prognostic markers in patients with pulmonary arterial hypertension

“…Recent studies have shown that the symptoms and outcomes of PAH are largely related to RV function (5) . Echocardiography is currently the image modality most widely used in evaluating the structure and function of the RV (6) . However, echocardiography is operator dependent and the image quality is often inadequate, especially for the RV (7) .…”

Prognostic value of biventricular mechanical parameters assessed using cardiac magnetic resonance feature‐tracking analysis to predict future cardiac events

“…It is no doubt that RVGLS is the most frequently mentioned index and the only RV strain parameter investigated in prior echocardiography studies, partly because it is tedious to acquire multiple RV‐focused short‐axis views to measure RVGCS and RVGRS . In pulmonary hypertension, de Siqueira et al demonstrated the prognostication of RV circumferential deformation, which was also the most significant RV deformation parameter for our secondary endpoint. Because RVGRS was not obtained in their study, comparison between RVGRS and RVGCS is unknown.…”

“…In an RV CMR‐FT analysis, Park et al reported good correlations of RVGLS between 2D speckle tracking echocardiography and MR‐FT in a small group of patients with ischemic cardiomyopathy. de Siqueira et al demonstrated the utility of RV global circumferential strain rate in prognostication in pulmonary hypertension.…”

CMR feature tracking left ventricular strain-rate predicts ventricular tachyarrhythmia, but not deterioration of ventricular function in patients with repaired tetralogy of Fallot

“…Myocardial deformation (strain), measured using cardiac magnetic resonance feature tracking, has shown to contain additive value in predicting outcome, when compared to conventional measurements of ventricular function and volume in various cardiovascular diseases [9,10]. Even in the absence of impaired ejection fraction (EF), strain variables are affected in heart failure, indicating that strain could be a more sensitive marker of myocardial dysfunction than EF [11].…”