National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
Eur Radiol. 2020 Jul;30(7):3672-3683. doi: 10.1007/s00330-020-06744-6. Epub 2020 Feb 27.
In some cardiac pathologies, impairment of left ventricular (LV) longitudinal function may precede reduction in LV ejection fraction. This study investigates the effectiveness of a fast method to quantify long-axis LV function compared to conventional feature tracking and manual approaches.
The study consisted of 50 normal controls and 100 heart failure (HF) patients including 40 with reduced ejection fraction (HFrEF), 30 with mid-range ejection fraction (HFmrEF), and 30 with preserved ejection fraction (HFpEF). Parameters including fast long-axis strain (FLAS) at end-systole and peak strain rates during systole (FLASR), early diastole (FLASR), and atrial contraction (FLASR) were derived by a fast semi-automated approach on cine cardiovascular magnetic resonance.
FLAS exhibited good agreement with strain values obtained using conventional feature tracking (bias - 2.9%, limits of agreement ± 3.0%) and the manual approach (bias 0.6%, limits of agreement ± 2.1%), where FLAS was more reproducible and required shorter measurement time. The mean FLAS (HFrEF < HFmrEF < HFpEF < controls; 6.1 ± 2.4 < 9.9 ± 2.4 < 11.0 ± 2.5 < 16.9 ± 2.3%, all p < 0.0001) was decreased in all the HF patient groups. A FLAS of 12.3% (mean-2SD of controls) predicted the presence of systolic dysfunction in 67% of patients with HFpEF, and 87% with HFmrEF. Strain parameters using the fast approach were superior to those obtained by conventional feature tracking and manual approaches for discriminating HFpEF from controls. Notable examples are area under the curve, sensitivity, and specificity for FLAS (0.94, 93%, and 86%) and FLASR (0.96, 90%, and 94%).
The fast approach-derived LV strain and strain rate parameters facilitate reproducible, reliable, and effective LV longitudinal function analysis.
• Left ventricular long-axis strain can be rapidly derived from cine CMR with shorter measurement time and higher reproducibility compared to conventional feature tracking and the manual approach. • Progressive reductions in left ventricular long-axis strain and strain rate measurements were observed from HFpEF, HFmrEF, to HFrEF group. • Based on long-axis strain, systolic abnormalities were evident in HFmrEF and HFpEF indicating common coexistence of systolic and diastolic dysfunction in the HF phenotypes.
在某些心脏病理学中，左心室（LV）纵向功能的损害可能先于 LV 射血分数的降低。本研究旨在探讨一种快速定量长轴 LV 功能的方法与传统的特征追踪和手动方法相比的有效性。
该研究纳入了 50 名正常对照者和 100 名心力衰竭（HF）患者，包括 40 名射血分数降低的心力衰竭（HFrEF）患者、30 名射血分数中间范围的心力衰竭（HFmrEF）患者和 30 名射血分数保留的心力衰竭（HFpEF）患者。通过快速半自动方法从心血管磁共振电影中获得参数，包括收缩末期快速长轴应变（FLAS）和收缩期峰值应变率（FLASR）、舒张早期（FLASR）和心房收缩期（FLASR）。
FLAS 与使用传统特征追踪（偏差-2.9%，一致性界限±3.0%）和手动方法（偏差 0.6%，一致性界限±2.1%）获得的应变值具有良好的一致性，其中 FLAS 更具可重复性且需要更短的测量时间。HF 患者组的平均 FLAS（HFrEF < HFmrEF < HFpEF < 对照组；6.1 ± 2.4 < 9.9 ± 2.4 < 11.0 ± 2.5 < 16.9 ± 2.3%，均 P < 0.0001）均降低。FLAS 为 12.3%（对照组平均值-2SD）可预测 67%的 HFpEF 患者和 87%的 HFmrEF 患者存在收缩功能障碍。与传统特征追踪和手动方法相比，使用快速方法获得的应变参数更有助于区分 HFpEF 与对照组。FLAS（曲线下面积、敏感性和特异性分别为 0.94、93%和 86%）和 FLASR（曲线下面积、敏感性和特异性分别为 0.96、90%和 94%）的显著示例。
快速方法衍生的 LV 应变和应变率参数可促进重复性好、可靠且有效的 LV 纵向功能分析。
与传统特征追踪和手动方法相比，从心血管磁共振电影中快速获得左心室长轴应变的时间更短、重复性更高。
从 HFpEF、HFmrEF 到 HFrEF 组，观察到左心室长轴应变和应变率测量值逐渐降低。
基于长轴应变，HFmrEF 和 HFpEF 存在收缩期异常，表明 HF 表型中常见收缩期和舒张期功能障碍共存。
