Fast assessment of long axis strain with standard cardiovascular magnetic resonance: a validation study of a novel parameter with reference values

Abstract

BackgroundAssessment of longitudinal function with cardiovascular magnetic resonance (CMR) is limited to measurement of systolic excursion of the mitral annulus (MAPSE) or elaborate strain imaging modalities. The aim of this study was to develop a fast assessable parameter for the measurement of long axis strain (LAS) with CMR.Methods40 healthy volunteers and 125 patients with different forms of cardiomyopathy were retrospectively analyzed. Four different approaches for the assessment of LAS with CMR measuring the distance between the LV apex and a line connecting the origins of the mitral valve leaflets in enddiastole and endsystole were evaluated. Values for LAS were calculated according to the strain formula.ResultsLAS derived from the distance of the epicardial apical border to the midpoint of the line connecting the mitral valve insertion points (LAS-epi/mid) proved to be the most reliable parameter for the assessment of LAS among the different approaches.LAS-epi/mid displayed the highest sensitivity (81.6 %) and specificity (97.5 %), furthermore showing the best correlation with feature tracking (FTI) derived transmural longitudinal strain (r = 0.85). Moreover, LAS-epi/mid was non-inferior to FTI in discriminating controls from patients (Area under the curve (AUC) = 0.95 vs. 0.94, p = NS). The time required for analysis of LAS-epi/mid was significantly shorter than for FTI (67 ± 8 s vs. 180 ± 14 s, p < 0.0001). Additionally, LAS-epi/mid performed significantly better than MAPSE (Delta AUC = 0.09; p < 0.005) and the ejection fraction (Delta AUC = 0.11; p = 0.0002).Reference values were derived from 234 selected healthy volunteers. Mean value for LAS-epi/mid was −17.1 ± 2.3 %. Mean values for men were significantly lower compared to women (−16.5 ± 2.2 vs. -17.9 ± 2.1 %; p < 0.0001), while LAS decreased with age.ConclusionsLAS-epi/mid is a novel and fast assessable parameter for the analysis of global longitudinal function with non-inferiority compared to transmural longitudinal strain.

Left ventricular long axis strain: a new prognosticator in non-ischemic dilated cardiomyopathy?

“…LAS has been shown to be a simple and rapidly assessable parameter representing global LV longitudinal function without necessity of post-processing software tools [ 20 ]. In the present study we evaluated for the first time the prognostic value of LAS in patients with NIDCM.…”

“…Lately, we established long axis strain (LAS) in CMR as a reliable and fast assessable parameter for LV global longitudinal function which provides high sensitivity and specificity in discriminating patients with cardiomyopathies from healthy subjects without the necessity of any additional offline deformation analysis software tools and without application of gadolinium contrast agents. Moreover, LAS analysis shows good inter- and intraobserver agreement and can be performed much faster than FTI derived strain analysis [ 20 ]. However, until now there exist no data about the prognostic value of LAS analysis in cardiomyopathies with reduced LVEF.…”

Longitudinal left ventricular function is globally depressed within a week of STEMI

“…Longitudinal strain was determined for the anterior, anteroseptal, inferoseptal, inferior, inferolateral and anterolateral walls of the LV by measuring the distance from the AVplane to the apex at ED and ES and dividing the difference by the ED distance as previously described and validated (Riffel et al, 2015):…”

Review of Journal of Cardiovascular Magnetic Resonance 2015

“…In this manuscript, the authors present a fast technique for the quantification of global LV longitudinal strain from standard CMR cine images [34]. Different approaches for the measurement of LV longitudinal strain were tested retrospectively in 125 patients with various forms of cardiomyopathy as well as in 40 controls.…”