Feature Tracking Myocardial Strain Incrementally Improves Prognostication in Myocarditis Beyond Traditional CMR Imaging Features

Fischer, Kady; Obrist, Sarah J.; Erne, Sophie A.; Stark, Anselm W.; Marggraf, Maximilian; Kaneko, Kensuke; Guensch, Dominik P.; Huber, Adrian Thomas; Greulich, Simon; Aghayev, Ayaz; Steigner, Michael L.; Blankstein, Ron; Kwong, Raymond Y.; Gräni, Christoph

doi:10.1016/j.jcmg.2020.04.025

Cited by 108 publications

(103 citation statements)

References 29 publications

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“…According to the literature, normal GLS values are associated with good prognosis in different patient populations with preserved EF. Furthermore, Andreini et al (19) have described that LVNC patients with good LV EF, good stroke volume, and without LV dilatation have less cardiac events and excellent outcome and survival rate (20)(21)(22). In contrast to our results, a recent publication described decreased GLS in patients with LVNC with a median LV EF of 54%, which is lower than the mean EF of our LVNC group (23).…”

Section: Discussioncontrasting

confidence: 94%

Left ventricular characteristics of noncompaction phenotype patients with good ejection fraction measured with cardiac magnetic resonance

Kiss¹,

Gregor²,

Furak³

et al. 2021

The Anatolian Journal of Cardiology

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Objective: We describe left ventricular (LV) volumes, myocardial and trabeculated muscle mass and strains with Cardiac magnetic resonance of a large cohort (n=81) who fulfilled the morphologic criteria of left ventricular noncompaction (LVNC) and had good ejection fraction (EF >55%) and compare them with healthy controls (n=81). Male and female patients were compared to matched controls and to each other. We also investigated the LV trabeculated muscle mass cutoff in male and female patients with LVNC. Methods: 81 participants with LVNC and 81 healthy controls were included. Male and female patients were compared to matched controls and to each other. We also investigated the left ventricular trabeculated muscle mass cut-off in male and female LVNC patients. Results: The LV parameters of the LVNC population were normal, but they had significantly higher volumes, myocardial and trabeculated muscle mass, and a significantly smaller EF than the controls. Similar differences were observed after stratifying by sex. The optimal LV trabeculated muscle mass cutoffs were 25.8 g/m 2 in men (area under the curve: 0.81) and 19.0 g/m 2 in women (area under the curve: 0.87). The patients had normal global strains but a significantly worse global circumferential strain (patients vs controls: −29.9±4.9 vs. −35.8±4.7%, p<0.05) and significantly higher circumferential mechanical dispersion than the controls (patients vs. controls: 7.6±4.2 vs. 6.1±2.8%; p<0.05). No diseaserelated strain differences were noted between men and women. Conclusion:The LV functional and strain characteristics of the LVNC cohort differed significantly from those of healthy participants; this might be caused by increased LV trabeculation, and its clinical relevance might be questionable. The LV trabeculated muscle mass was very different between men and women; thus, the use of sex-specific morphologic diagnostic criteria should be considered.

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Section: Discussioncontrasting

confidence: 94%

Left ventricular characteristics of noncompaction phenotype patients with good ejection fraction measured with cardiac magnetic resonance

Kiss¹,

Gregor²,

Furak³

et al. 2021

The Anatolian Journal of Cardiology

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“…Myocardial strain analysis allows for a more detailed quantitative analysis of myocardial deformation and performance on a global and segmental level. Diagnostically, deficiencies in resting CMR-FT of both the left and right ventricle has been shown to be linked to outcome in multiple ischemic and non-ischemic cohorts (8)(9)(10). In these studies, strain analysis showed more subtle abnormalities in the absence of global systolic dysfunction and is thus interpreted to be an earlier and more sensitive prognostic modality than conventional assessment of global function alone.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Myocardial Function During Blood Pressure Manipulations Using Feature Tracking Cardiovascular Magnetic Resonance

Fischer

Neuenschwander

Jung

et al. 2021

Front. Cardiovasc. Med.

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Background: Coronary autoregulation is a feedback system, which maintains near-constant myocardial blood flow over a range of mean arterial pressure (MAP). Yet in emergency or peri-operative situations, hypotensive or hypertensive episodes may quickly arise. It is not yet established how rapid blood pressure changes outside of the autoregulation zone (ARZ) impact left (LV) and right ventricular (RV) function. Using cardiovascular magnetic resonance (CMR) imaging, measurements of myocardial tissue oxygenation and ventricular systolic and diastolic function can comprehensively assess the heart throughout a range of changing blood pressures.Design and methods: In 10 anesthetized swine, MAP was varied in steps of 10–15 mmHg from 29 to 196 mmHg using phenylephrine and urapidil inside a 3-Tesla MRI scanner. At each MAP level, oxygenation-sensitive (OS) cine images along with arterial and coronary sinus blood gas samples were obtained and blood flow was measured from a surgically implanted flow probe on the left anterior descending coronary artery. Using CMR feature tracking-software, LV and RV circumferential systolic and diastolic strain parameters were measured from the myocardial oxygenation cines.Results: LV and RV peak strain are compromised both below the lower limit (LV: Δ1.2 ± 0.4%, RV: Δ4.4 ± 1.2%, p < 0.001) and above the upper limit (LV: Δ2.1 ± 0.4, RV: Δ5.4 ± 1.4, p < 0.001) of the ARZ in comparison to a baseline of 70 mmHg. LV strain demonstrates a non-linear relationship with invasive and non-invasive measures of oxygenation. Specifically for the LV at hypotensive levels below the ARZ, systolic dysfunction is related to myocardial deoxygenation (β = −0.216, p = 0.036) in OS-CMR and both systolic and diastolic dysfunction are linked to reduced coronary blood flow (peak strain: β = −0.028, p = 0.047, early diastolic strain rate: β = 0.026, p = 0.002). These relationships were not observed at hypertensive levels.Conclusion: In an animal model, biventricular function is compromised outside the coronary autoregulatory zone. Dysfunction at pressures below the lower limit is likely caused by insufficient blood flow and tissue deoxygenation. Conversely, hypertension-induced systolic and diastolic dysfunction points to high afterload as a cause. These findings from an experimental model are translatable to the clinical peri-operative environment in which myocardial deformation may have the potential to guide blood pressure management, in particular at varying individual autoregulation thresholds.

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“…strain) to describe functional recovery of the myocardium from accidental severe hypothermic arrest has not been reported. However, they can be expected to allow earlier detection of subclinical abnormalities and may improve prognostic accuracy compared with standard measurements, such as EF ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Resolution of Strain Abnormalities During Extracorporeal Rewarming From Accidental Hypothermic Cardiac Arrest Following Avalanche Burial

et al. 2021

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A hypothermic avalanche victim underwent, during extracorporeal warming from asystolic arrest, 3-dimensional transesophageal echocardiography. At 33°C core temperature, left ventricular ejection fraction had recovered, whereas myocardial strain still demonstrated significant dysfunction until 36°C. Deformation analysis seems more sensitive than global assessment during myocardial recovery from hypothermic cardiac arrest. ( Level of Difficulty: Intermediate. )

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Feature Tracking Myocardial Strain Incrementally Improves Prognostication in Myocarditis Beyond Traditional CMR Imaging Features

Cited by 108 publications

References 29 publications

Left ventricular characteristics of noncompaction phenotype patients with good ejection fraction measured with cardiac magnetic resonance

Left ventricular characteristics of noncompaction phenotype patients with good ejection fraction measured with cardiac magnetic resonance

Assessment of Myocardial Function During Blood Pressure Manipulations Using Feature Tracking Cardiovascular Magnetic Resonance

Resolution of Strain Abnormalities During Extracorporeal Rewarming From Accidental Hypothermic Cardiac Arrest Following Avalanche Burial

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