Feasibility of CT-derived myocardial strain measurement in patients with advanced cardiac valve disease

Abstract

To explore the feasibility of CT-derived myocardial strain measurement in patients with advanced cardiac valve disease and to compare it to strain measurements derived from transthoracic echocardiography (TTE). 43 consecutive patients with advanced cardiac valve disease and clinically indicated retrospectively gated cardiac CTs were retrospectively analyzed. The longitudinal, circumferential as well as radial systolic strain were determined in all patients utilizing a commercially available CT strain software. In 36/43 (84%) patients, CT-derived longitudinal strain was compared to speckle-tracking TTE. Pearson’s correlation coefficients as well as Bland–Altman analysis were used to compare the CT-derived strain measurements to TTE. The intra- and inter-reader-reliability of the CT-derived strain measurements were assessed by intra-class correlation coefficients (ICCs). Strain measurements were feasible in all patients. CT-derived global longitudinal strain (GLS) correlated moderately with TTE-derived GLS (r = 0.6, p < 0.001). A moderate correlation between CT-derived GLS and CT-derived left ventricular ejection fraction was found (LVEF, r = − 0.66, p = 0.036). Bland–Altman analysis showed a systematic underestimation of myocardial strain by cardiac CT compared to TTE (mean difference: − 5.8%, 95% limit of agreement between − 13.3 and 1.8%). Strain measurements showed an excellent intra- and inter-reader-reliability with an intra-reader ICC of 1.0 and an inter-reader ICC of 0.99 for GLS measurements. CT-derived myocardial strain measurements are feasible in patients with advanced cardiac valve disease. They are highly reproducible and correlate with established parameters of strain measurements. Our results encourage the implementation of CT-derived strain measurement into clinical routine.

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“…Moreover, it should be remembered that the peak strain values are underestimated in the computed tomography assessment in relation to the echocardiographic assessment. In the recently published literature standardizing the CT-derived myocardial strain measurement, it has been shown that computed tomography significantly underestimates the strain values relative to echocardiographic assessment [ 11 ]. Ammon et al showed that the highest predictive accuracy for the echocardiographic GLS < 18% criterion is characterized by the computed tomography-derived GLS < 12% criterion [ 32 ].…”

“…Strain can be assessed by echocardiography (ECHO) and have a utility in prognosing patients with coronary artery disease (CAD), mitral stenosis, and other cardiac diseases [ 8 ]. Next to ECHO, it is possible to measure strain using magnetic resonance imaging (MRI) [ 9 ] and computed tomography (CT) [ 10 , 11 ]. Global longitudinal strain (GLS) has better prognostic value in predicting adverse cardiac events than left ventricular ejection fraction (LVEF) measurements.…”

“…Global longitudinal strain (GLS) has better prognostic value in predicting adverse cardiac events than left ventricular ejection fraction (LVEF) measurements. Obtaining strain measurements using cardiac CT have high repeatability and does not depend on external factors [ 11 , 12 ]. Left ventricular global longitudinal strain (LV GLS) measurements are independent predictor for reverse remodeling of LV and for patients with sinus rhythm the optimal cut off value is − 10% [ 13 ].…”

Novel Cardiac Computed Tomography Methods for the Assessment of Anthracycline Induced Cardiotoxicity

“…A recently published approach employed a spatial-sequential network with bi-directional learning of 4D CT images which out-performed existing approaches for automated LV segmentation ( 40 ). Currently, there are commercially available programs for calculation of regional myocardial strain from contrast cine CT but these are based on 2D analysis of stacks of images ( 41 ). Although CT imaging holds promise for true high-resolution 3D analysis of regional myocardial strain, to date CT derived strain has not yet been assessed as a tool for the early prediction of AIC.…”

Regional left ventricular endocardial strains estimated from low‐dose 4DCT: Comparison with cardiac magnetic resonance feature tracking

“…Previous studies have used 4DCT to estimate LV myocardial function. [17][18][19][20][21] Lamash et al used a deformable LV model to estimate regional and global myocardial strains from 3D velocity fields which were extracted via a novel optical flow technique. 17 The model was then used to successfully differentiate between normal and abnormal myocardial segments in a cohort of 93 subjects with cardiac 4DCT scans.…”