Skip to main content

Advertisement

SpringerLink
Log in

Feature Tracking-Derived Peak Systolic Strain Compared to Late Gadolinium Enhancement in Troponin-Positive Myocarditis: A Case–Control Study

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Cardiac magnetic resonance (CMR) assesses myocardial involvement in myocarditis (MYO). Current techniques are qualitative, subjective, and prone to interpretation error. Feature tracking (FT) analyzes myocardial strain using CMR and has not been examined in MYO. We hypothesize that regional left ventricular (LV) strain is abnormal in MYO. Regional strain by FT was compared to late gadolinium enhancement (LGE) and troponin leak as measures of myocardial involvement. This single-center, retrospective CMR study reviewed patients with clinical MYO and structurally normal hearts who underwent CMR at our institution. Young adults with normal cardiac anatomy, function, and absent LGE served as controls. MYO patients with documented troponin leak and normal global ejection fraction (EF > 50 %) were included in comparison. FT determined regional myocardial peak systolic strain (pkS) in longitudinal and circumferential distributions. T tests compared strain values between cases and controls. Receiver operating characteristic curves determined pkS values with highest sensitivity and specificity for concurrent troponin leak and LGE. FT was performed on 57 patients: 37 MYO and 20 controls. Twenty-eight cases with normal EF, and 20 control patients were included in final analysis. Nearly all cases with normal function demonstrated abnormal regional pkS (27/28, 96 %). Cases had significantly diminished pkS when compared to controls in all regions except the longitudinal 2C distribution. FT-derived longitudinal and circumferential pkS is sensitive and specific in identifying myocardial involvement, namely the presence of troponin leak and LGE. FT may be a useful adjunctive, objective measure of myocardial involvement in patients with MYO and normal LV function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CMR:

Cardiac magnetic resonance imaging

MYO:

Myocarditis

FT:

Feature tracking

LV:

Left ventricular

EF:

Ejection fraction

LGE:

Late gadolinium enhancement

pkS:

Peak systolic strain

4C:

Four chamber

2C:

Two chamber

References

  1. Ashford MW, Liu W, Lin SJ, Abraszewski P, Caruthers SD, Connolly AM et al (2005) Occult cardiac contractile dysfunction in dystrophin-deficient children revealed by cardiac magnetic resonance strain imaging. Circulation 112(16):2462–2467

    Article  PubMed  Google Scholar 

  2. Augustine D, Lewandowski AJ, Lazdam M, Rai A, Francis J, Myerson S et al (2013) Global and regional left ventricular myocardial deformation measures by magnetic resonance feature tracking in healthy volunteers: comparison with tagging and relevance of gender. J Cardiovasc Magn Reson 15:8

    Article  PubMed  PubMed Central  Google Scholar 

  3. Baccouche H, Mahrholdt H, Meinhardt G, Merher R, Voehringer M, Hill S et al (2009) Diagnostic synergy of non-invasive cardiovascular magnetic resonance and invasive endomyocardial biopsy in troponin-positive patients without coronary artery disease. Eur Heart J 30(23):2869–2879

    Article  CAS  PubMed  Google Scholar 

  4. Banka P, Robinson J, Uppu S, Harris M, Hasbani K, Lai W et al (2015) CMR techniques and findings in children with myocarditis: a multicenter retrospective study. J Cardiovasc Magn Reson 17:96

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Int J Cardiovasc Imaging 18(1):539–542

    PubMed  Google Scholar 

  6. Cho GY, Chan J, Leano R, Strudwick M, Marwick TH (2006) Comparison of two-dimensional speckle and tissue velocity based strain and validation with harmonic phase magnetic resonance imaging. Am J Cardiol 97(11):1661–1666

    Article  PubMed  Google Scholar 

  7. Francone M, Chimenti C, Galea N, Scopelliti F, Verardo R, Galea R et al (2014) CMR sensitivity varies with clinical presentation and extent of cell necrosis in biopsy-proven acute myocarditis. JACC Cardiovasc Imaging 7(3):254–263

    Article  PubMed  Google Scholar 

  8. Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT et al (2009) Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol 53(17):1475–1487

    Article  PubMed  PubMed Central  Google Scholar 

  9. Greulich S, Ferreira VM, Dall’Armellina E, Mahrholdt H (2015) Myocardial inflammation—Are we there yet? Curr Cardiovasc Imaging Rep 8(3):6

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hinojar R, Foote L, Ucar EA, Jackson T, Jabbour A, Yu CY et al (2015) Native T1 in discrimination of acute and convalescent stages in patients with clinical diagnosis of myocarditis: a proposed diagnostic algorithm using CMR. JACC Cardiovasc Imaging 8(1):37–46

    Article  PubMed  Google Scholar 

  11. Ho SY (2009) Anatomy and myoarchitecture of the left ventricular wall in normal and in disease. Eur J Echocardiogr 10(8):iii3–iii7

    Article  PubMed  Google Scholar 

  12. Hor KN, Wansapura J, Markham LW, Mazur W, Cripe LH, Fleck R et al (2009) Circumferential strain analysis identifies strata of cardiomyopathy in Duchenne muscular dystrophy: a cardiac magnetic resonance tagging study. J Am Coll Cardiol 53(14):1204–1210

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hor KN, Gottliebson WM, Carson C, Wash E, Cnota J, Fleck R et al (2010) Comparison of magnetic resonance feature tracking for strain calculation with harmonic phase imaging analysis. JACC Cardiovasc Imaging 3(2):144–151

    Article  PubMed  Google Scholar 

  14. Hor KN, Gottliebson WM, Carson C, Wash E, Cnota J, Fleck R et al (2010) Comparison of magnetic resonance feature tracking for strain calculation with harmonic phase imaging analysis. JACC Cardiovasc Imaging 3(2):144–151

    Article  PubMed  Google Scholar 

  15. Kempny A, Fernández-Jiménez R, Orwat S, Schuler P, Bunck AC, Maintz D et al (2012) Quantification of biventricular myocardial function using cardiac magnetic resonance feature tracking, endocardial border delineation and echocardiographic speckle tracking in patients with repaired tetralogy of Fallot and healthy controls. J Cardiovasc Magn Reson 14:32

    Article  PubMed  PubMed Central  Google Scholar 

  16. Khoo NS, Smallhorn JF, Atallah J, Kaneko S, Mackie AS, Paterson I (2012) Altered left ventricular tissue velocities, deformation and twist in children and young adults with acute myocarditis and normal ejection fraction. J Am Soc Echocardiogr 25(3):294–303

    Article  PubMed  Google Scholar 

  17. Mahrholdt H, Goedecke C, Wagner A, Meinhardt G, Athanasiadis A, Vogelsberg H et al (2004) Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 109(10):1250–1258

    Article  PubMed  Google Scholar 

  18. Morton G, Schuster A, Jogiya R, Kutty S, Beerbaum P, Nagel E (2012) Inter-study reproducibility of cardiovascular magnetic resonance myocardial feature tracking. J Cardiovasc Magn Reson 14:43

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rosen BD, Edvardsen T, Lai S, Castillo E, Pan L, Jerosch-Herold M et al (2005) Left ventricular concentric remodeling is associated with decreased global and regional systolic function: the multi-ethnic study of atherosclerosis. Circulation 112(7):984–991

    Article  PubMed  Google Scholar 

  20. Rosen BD, Saad MF, Shea S, Nasir K, Edvardsen T, Burke G et al (2006) Hypertension and smoking are associated with reduced regional left ventricular function in asymptomatic: individuals the multi-ethnic study of atherosclerosis. J Am Coll Cardiol 47(6):1150–1158

    Article  PubMed  Google Scholar 

  21. Rosset A, Spadola L, Ratib O (2004) OsiriX: an open-source software for navigating in multidimensional DICOM images. J Digit Imaging 17(3):205–216

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schuster A, Morton G, Hussain ST, Jogiya R, Kutty S, Asrress KN et al (2013) The intra-observer reproducibility of cardiovascular magnetic resonance myocardial feature tracking strain assessment is independent of field strength. Eur J Radiol 82(2):296–301

    Article  PubMed  Google Scholar 

  23. Sengupta PP, Tajik AJ, Chandrasekaran K, Khandheria BK (2008) Twist mechanics of the left ventricle: principles and application. JACC Cardiovasc Imaging 1(3):366–376

    Article  PubMed  Google Scholar 

  24. Sutherland GR, Di Salvo G, Claus P, D’hooge J, Bijnens B (2004) Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr 17(7):788–802

    Article  PubMed  Google Scholar 

  25. Uppu SC, Shah A, Weigand J, Nielsen JC, Ko HH, Parness IA et al (2015) Two-dimensional speckle-tracking-derived segmental peak systolic longitudinal strain identifies regional myocardial involvement in patients with myocarditis and normal global left ventricular systolic function. Pediatr Cardiol 36 (5):950–959

    Article  PubMed  Google Scholar 

  26. Yeon SB, Reichek N, Tallant BA, Lima JA, Calhoun LP, Clark NR et al (2001) Validation of in vivo myocardial strain measurement by magnetic resonance tagging with sonomicrometry. J Am Coll Cardiol 38(2):555–561

    Article  CAS  PubMed  Google Scholar 

Download references

Author’s Contribution

James C. Nielsen, MD, was instrumental in study design, data analysis and interpretation, and critical revision of the manuscript. JN served as one of the two CMR readers for late gadolinium enhancement in myocarditis patients. JN was directly involved in critical revisions of the manuscript. Partho P. Sengupta, MD, was key to interpretation of feature tracking data, provided feature tracking interpretation, and was directly involved in critical revisions of the manuscript. Javier Sanz, MD, was key to interpretation of feature tracking data, provided feature tracking interpretation, and was directly involved in critical revisions of the manuscript. Shubhika Srivastava, MD, was directly involved in statistical analysis, data interpretation, presentation of results, as well as acting as a key editor on all manuscript revisions. Santosh Uppu, MD, was a critical contributor to study concept, design, data analysis, and statistical interpretation. SU served as one of the two CMR readers for late gadolinium enhancement in myocarditis patients. SU was directly involved in critical revisions of the manuscript.

Author information

Authors and Affiliations

  1. Division of Pediatric Cardiology, Children’s Hospital of San Antonio/Baylor College of Medicine, 315 N. San Saba Street Suite 1135, San Antonio, TX, 78207, USA

    Justin Weigand

  2. Department of Radiology and Pediatric Cardiology, Stony Brook Children’s Hospital, 100 Nicolls Road, Stony Brook, NY, 11794, USA

    James C. Nielsen

  3. Department of Cardiology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA

    Partho P. Sengupta & Javier Sanz

  4. Division of Pediatric Cardiology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1201, New York, NY, 10029, USA

    Shubhika Srivastava & Santosh Uppu

Authors
  1. Justin Weigand
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James C. Nielsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Partho P. Sengupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Javier Sanz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shubhika Srivastava
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Santosh Uppu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Justin Weigand.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weigand, J., Nielsen, J.C., Sengupta, P.P. et al. Feature Tracking-Derived Peak Systolic Strain Compared to Late Gadolinium Enhancement in Troponin-Positive Myocarditis: A Case–Control Study. Pediatr Cardiol 37, 696–703 (2016). https://doi.org/10.1007/s00246-015-1333-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-015-1333-z

Keywords

Search

Navigation