Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str, 33,, 48149, Münster, Germany.
J Cardiovasc Magn Reson. 2012 May 31;14(1):32. doi: 10.1186/1532-429X-14-32.
Parameters of myocardial deformation have been suggested to be superior to conventional measures of ventricular function in patients with tetralogy of Fallot (ToF), but have required non-routine, tagged cardiovascular magnetic resonance (CMR) techniques. We assessed biventricular myocardial function using CMR cine-based feature tracking (FT) and compared it to speckle tracking echocardiography (STE) and to simple endocardial border delineation (EBD). In addition, the relation between parameters of myocardial deformation and clinical parameters was assessed.
Overall, 28 consecutive adult patients with repaired ToF (age 40.4 ± 13.3 years) underwent standard steady-state-free precession sequence CMR, echocardiography, and cardiopulmonary exercise testing. In addition, 25 healthy subjects served as controls. Myocardial deformation was assessed by CMR based FT (TomTec Diogenes software), CMR based EBD (using custom written software) and STE (TomTec Cardiac Performance Analysis software).
Feature tracking was feasible in all subjects. A close agreement was found between measures of global left (LV) and right ventricular (RV) global strain. Interobserver agreement for FT and STE was similar for longitudinal LV global strain, but FT showed better inter-observer reproducibility than STE for circumferential or radial LV and longitudinal RV global strain. Reproducibility of regional strain on FT was, however, poor. The relative systolic length change of the endocardial border measured by EBD yielded similar results to FT global strain. Clinically, biventricular longitudinal strain on FT was reduced compared to controls (P < 0.0001) and was related to the number of previous cardiac operations. In addition, FT derived RV strain was related to exercise capacity and VE/VCO2-slope.
Although neither the inter-study reproducibility nor accuracy of FT software were investigated, and its inter-observer reproducibility for regional strain calculation was poor, its calculations of global systolic strain showed similar or better inter-oberver reproducibility than those by STE, and could be applied across RV image regions inaccessible to echo. 'Global strain' calculated by EBD gave similar results to FT. Measurements made using FT related to exercise tolerance in ToF patients suggesting that the approach could have clinical relevance and deserves further study.
已有研究表明，在法洛四联症（ToF）患者中，心肌变形参数优于传统的心室功能测量方法，但需要使用非常规的、带标记的心血管磁共振（CMR）技术。我们使用 CMR 电影式特征跟踪（FT）评估双心室心肌功能，并将其与斑点追踪超声心动图（STE）和简单的心内膜边界描绘（EBD）进行比较。此外，还评估了心肌变形参数与临床参数之间的关系。
共有 28 例连续的成人 ToF 修复患者（年龄 40.4±13.3 岁）接受了标准稳态无预激序列 CMR、超声心动图和心肺运动试验。此外，25 名健康受试者作为对照组。通过 CMR 基于 FT（TomTec Diogenes 软件）、CMR 基于 EBD（使用自定义编写的软件）和 STE（TomTec Cardiac Performance Analysis 软件）评估心肌变形。
FT 可在所有受试者中实施。左心室（LV）和右心室（RV）整体应变的整体测量值之间存在密切的一致性。FT 和 STE 的纵向 LV 整体应变的观察者间一致性相似，但 FT 的观察者间可重复性优于 STE 的观察者间可重复性，对于 LV 的圆周或径向整体应变和 RV 的纵向整体应变。然而，FT 的区域性应变的重复性较差。EBD 测量的心内膜边界的相对收缩长度变化与 FT 整体应变产生相似的结果。临床上，与对照组相比，FT 的双心室纵向应变降低（P<0.0001），并且与先前的心脏手术数量有关。此外，FT 衍生的 RV 应变与运动能力和 VE/VCO2-斜率有关。
尽管未研究 FT 软件的组间可重复性或准确性，并且其用于区域性应变计算的观察者间可重复性较差，但它的整体收缩应变计算显示出与 STE 相似或更好的观察者间可重复性，并且可应用于超声心动图无法到达的 RV 图像区域。EBD 计算的“整体应变”与 FT 相似。FT 测量值与 ToF 患者的运动耐量相关，表明该方法具有临床意义，值得进一步研究。
