Camilla Kjellstad Larsen1,2,3,4, John M Aalen1,2,3,4, Caroline Stokke5,6,7, Jan Gunnar Fjeld6,7, Erik Kongsgaard2,3, Jürgen Duchenne8,9, Ganna Degtiarova10,11, Olivier Gheysens10,11, Jens-Uwe Voigt8,9, Otto A Smiseth1,2,3,4, Einar Hopp2,6. 1. Institute for Surgical Research, Oslo University Hospital, Oslo, Norway. 2. Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway. 3. Department of Cardiology, Oslo University Hospital, Oslo, Norway. 4. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 5. Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway. 6. Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway. 7. Oslo Metropolitan University, Oslo, Norway. 8. Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium. 9. Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium. 10. Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium. 11. Department of Imaging and Pathology, KU Leuven - University of Leuven, Leuven, Belgium.
Abstract
AIMS: Regional myocardial work may be assessed by pressure-strain analysis using a non-invasive estimate of left ventricular pressure (LVP). Strain by speckle tracking echocardiography (STE) is not always accessible due to poor image quality. This study investigated the estimation of regional myocardial work from strain by feature tracking (FT) cardiac magnetic resonance (CMR) and non-invasive LVP. METHODS AND RESULTS: Thirty-seven heart failure patients with reduced ejection fraction, left bundle branch block (LBBB), and no myocardial scar were compared to nine controls without LBBB. Circumferential strain was measured by FT-CMR in a mid-ventricular short-axis cine view, and longitudinal strain by STE. Segmental work was calculated by pressure-strain analysis. Twenty-five patients underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography. Segmental values were reported as percentages of the segment with maximum myocardial FDG uptake. In LBBB patients, net CMR-derived work was 51 ± 537 (mean ± standard deviation) in septum vs. 1978 ± 1084 mmHg·% in the left ventricular (LV) lateral wall (P < 0.001). In controls, however, there was homogeneous work distribution with similar values in septum and the LV lateral wall (non-significant). Reproducibility was good. Segmental CMR-derived work correlated with segmental STE-derived work and with segmental FDG uptake (average r = 0.71 and 0.80, respectively). CONCLUSION: FT-CMR in combination with non-invasive LVP demonstrated markedly reduced work in septum compared to the LV lateral wall in patients with LBBB. Work distribution correlated with STE-derived work and energy demand as reflected in FDG uptake. These results suggest that FT-CMR in combination with non-invasive LVP is a relevant clinical tool to measure regional myocardial work.
AIMS: Regional myocardial work may be assessed by pressure-strain analysis using a non-invasive estimate of left ventricular pressure (LVP). Strain by speckle tracking echocardiography (STE) is not always accessible due to poor image quality. This study investigated the estimation of regional myocardial work from strain by feature tracking (FT) cardiac magnetic resonance (CMR) and non-invasive LVP. METHODS AND RESULTS: Thirty-seven heart failurepatients with reduced ejection fraction, left bundle branch block (LBBB), and no myocardial scar were compared to nine controls without LBBB. Circumferential strain was measured by FT-CMR in a mid-ventricular short-axis cine view, and longitudinal strain by STE. Segmental work was calculated by pressure-strain analysis. Twenty-five patients underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography. Segmental values were reported as percentages of the segment with maximum myocardial FDG uptake. In LBBBpatients, net CMR-derived work was 51 ± 537 (mean ± standard deviation) in septum vs. 1978 ± 1084 mmHg·% in the left ventricular (LV) lateral wall (P < 0.001). In controls, however, there was homogeneous work distribution with similar values in septum and the LV lateral wall (non-significant). Reproducibility was good. Segmental CMR-derived work correlated with segmental STE-derived work and with segmental FDG uptake (average r = 0.71 and 0.80, respectively). CONCLUSION: FT-CMR in combination with non-invasive LVP demonstrated markedly reduced work in septum compared to the LV lateral wall in patients with LBBB. Work distribution correlated with STE-derived work and energy demand as reflected in FDG uptake. These results suggest that FT-CMR in combination with non-invasive LVP is a relevant clinical tool to measure regional myocardial work.
Authors: Philippe C Wouters; Geert E Leenders; Maarten J Cramer; Mathias Meine; Frits W Prinzen; Pieter A Doevendans; Bart W L De Boeck Journal: Int J Cardiovasc Imaging Date: 2021-02-05 Impact factor: 2.357