Pediatric Cardiology

, Volume 39, Issue 3, pp 478–483 | Cite as

Myocardial Strain Using Cardiac MR Feature Tracking and Speckle Tracking Echocardiography in Duchenne Muscular Dystrophy Patients

  • Bryan Siegel
  • Laura Olivieri
  • Heather Gordish-Dressman
  • Christopher F. Spurney
Original Article


Duchenne muscular dystrophy (DMD) is an inherited X-linked disorder with an incidence of 1 in 3500 male births, and cardiomyopathy is becoming the leading cause of death. While Cardiac MRI (CMR) and late gadolinium enhancement (LGE) are important tools in recognizing myocardial involvement, myocardial strain imaging may demonstrate early changes and allow patients to avoid gadolinium contrast. We performed CMR feature tracking (FT) and echo-based speckle tracking (STE) strain measures on DMD patients and age/sex matched controls who had received a CMR with contrast and transthoracic echocardiogram. Data were collected for longitudinal strain in the apical four-chamber view and circumferential strain in the mid-papillary parasternal short axis. Segmental wall analysis was performed and compared with the presence of LGE. Data were analyzed using student’s t tests or one-way ANOVA adjusting for multiple comparisons. We measured 24 subjects with DMD and 8 controls. Thirteen of 24 DMD subjects were LGE positive only in the lateral segments in short-axis views. Average circumferential strain (CS) measured by FT was significantly decreased in DMD compared to controls (− 18.8 ± 6.1 vs. − 25.5 ± 3.2; p < 0.001) and showed significant differences in the anterolateral, inferolateral, and inferior segments. Average CS by STE trended towards significance (p = 0.06) but showed significance in only the inferior segment. FT showed significant differences in the inferolateral segment between LGE positive (− 15.5 ± 9.0) and LGE negative (− 18.2 ± 8.3) in DMD subjects compared to controls (− 28.6 ± 7.3; p ≤ 0.04). FT also showed significant differences between anteroseptal and inferolateral segments within LGE-positive (p < 0.003) and LGE-negative (p < 0.03) DMD subjects while STE did not. There were no significant differences in longitudinal strain measures. CMR-FT-derived myocardial strain was able to demonstrate differences between subjects with DMD and controls not detected by STE. FT was also able to demonstrate differences in LGE-positive and LGE-negative segments within patients with DMD. FT may be able to predict LGE-positive segments in DMD without the use of gadolinium contrast.


Cardiac MR Feature tracking Duchenne muscular dystrophy cardiomyopathy Speckle tracking echocardiography Late gadolinium enhancement 


Compliance with Ethical Standards

Conflict of interest

Bryan Siegel declares that he has no conflict of interest. Laura Olivieri declares that she has no conflict of interest. Heather Gordish-Dressman declares that she has no conflict of interest. Christopher Spurney declares that he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Research Involving Animal and Human Rights

This article does not contain any studies with animals performed by any of the authors.


  1. 1.
    Eagle M, Baudouin SV, Chandler C et al (2002) Survival in Duchenne muscular dystrophy: improvements in life expectancy since 1967 and the impact of home nocturnal ventilation. Neuromuscul Disord 12:926–929. CrossRefPubMedGoogle Scholar
  2. 2.
    McNally EM, Kaltman JR, Woodrow Benson D et al (2015) Contemporary cardiac issues in Duchenne muscular dystrophy. Circulation 131:1590–1598. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Spurney C, Shimizu R, Morgenroth LP et al (2014) Cooperative international neuromuscular research group duchenne natural history study demonstrates insufficient diagnosis and treatment of cardiomyopathy in duchenne muscular dystrophy. Muscle Nerve 50:250–256. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Spurney CF, McCaffrey FM, Cnaan A et al (2015) Feasibility and reproducibility of echocardiographic measures in children with muscular dystrophies. J Am Soc Echocardiogr 28:999–1008. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Taqatqa A, Bokowski J, Al-Kubaisi M et al (2016) The use of speckle tracking echocardiography for early detection of myocardial dysfunction in patients with duchenne muscular dystrophy. Pediatr Cardiol 37:1422–1428. CrossRefPubMedGoogle Scholar
  6. 6.
    Ryan TD, Taylor MD, Mazur W et al (2013) Abnormal circumferential strain is present in young duchenne muscular dystrophy patients. Pediatr Cardiol 34:1159–1165. CrossRefPubMedGoogle Scholar
  7. 7.
    Soslow JH, Xu M, Slaughter JC et al (2016) Evaluation of echocardiographic measures of left ventricular function in patients with duchenne muscular dystrophy: assessment of reproducibility and comparison to cardiac magnetic resonance imaging. J Am Soc Echocardiogr 37232:1–9. Google Scholar
  8. 8.
    Malayeri AA, Brooks KM, Bryant LH et al (2016) National institutes of health perspective on reports of gadolinium deposition in the brain. J Am Coll Radiol 13:237–241. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Pedrizzetti G, Claus P, Kilner PJ, Nagel E (2016) Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use. J Cardiovasc Magn Reson. PubMedGoogle Scholar
  10. 10.
    Hor KN, Gottliebson WM, Carson C et al (2010) Comparison of magnetic resonance feature tracking for strain calculation with harmonic phase imaging analysis. JACC Cardiovasc Imaging. PubMedGoogle Scholar
  11. 11.
    Bogarapu S, Puchalski MD, Everitt MD et al (2016) Novel cardiac magnetic resonance feature tracking (CMR-FT) analysis for detection of myocardial fibrosis in pediatric hypertrophic cardiomyopathy. Pediatr Cardiol 37:663–673. CrossRefPubMedGoogle Scholar
  12. 12.
    Baessler B, Schaarschmidt F, Dick A et al (2016) Diagnostic implications of magnetic resonance feature tracking derived myocardial strain parameters in acute myocarditis. Eur J Radiol 85:218–227. CrossRefPubMedGoogle Scholar
  13. 13.
    Bhatti S, Vallurupalli S, Ambach S et al (2016) Myocardial strain pattern in patients with cardiac amyloidosis secondary to multiple myeloma: a cardiac MRI feature tracking study. Int J Cardiovasc ImagingGoogle Scholar
  14. 14.
    Bratis K, Hachmann P, Child N et al (2017) Cardiac magnetic resonance feature tracking in Kawasaki disease convalescence. Ann Pediatr Cardiol 10:18–25. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Berganza FM, de Alba CG, Özcelik N, Adebo D (2017) Cardiac magnetic resonance feature tracking biventricular two-dimensional and three-dimensional strains to evaluate ventricular function in children after repaired tetralogy of fallot as compared with healthy children. Pediatr Cardiol 38:566–574. CrossRefPubMedGoogle Scholar
  16. 16.
    Cross R, Olivieri L, Brien KO et al (2016) Improved workflow for quantification of left ventricular volumes and mass using free- breathing motion corrected cine imaging. J Cardiovasc Magn Reson. Google Scholar
  17. 17.
    Olivieri L, Cross R, Brien KJO et al (2016) Free-breathing motion-corrected late-gadolinium-enhancement imaging improves image quality in children. Pediatr Radiol. PubMedGoogle Scholar
  18. 18.
    Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. J Cardiovasc Magn Reson 4:203–210. CrossRefGoogle Scholar
  19. 19.
    Hor KN, Kissoon N, Mazur W et al (2014) Regional circumferential strain is a biomarker for disease severity in duchenne muscular dystrophy heart disease: a cross-sectional study. Pediatr Cardiol 36:111–119. CrossRefPubMedGoogle Scholar
  20. 20.
    Aurich M, Keller M, Greiner S et al (2016) Left ventricular mechanics assessed by two-dimensional echocardiography and cardiac magnetic resonance imaging: comparison of high-resolution speckle tracking and feature tracking. Eur Hear J Cardiovasc Imaging 17:1370. CrossRefGoogle Scholar
  21. 21.
    Nigro G, Comi LI, Politano L, Bain RJI (1990) The incidence and evolution of cardiomyopathy in Duchenne muscular dystrophy. Int J Cardiol 26:271–277. CrossRefPubMedGoogle Scholar
  22. 22.
    Kamdar F, Garry DJ (2016) Dystrophin-deficient cardiomyopathy. J Am Coll Cardiol 67:2533–2546. CrossRefPubMedGoogle Scholar
  23. 23.
    Bilchick KC, Salerno M, Plitt D et al (2011) Prevalence and distribution of regional scar in dysfunctional myocardial segments in Duchenne muscular dystrophy. J Cardiovasc Magn Reson 13:20. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Hor KN, Taylor MD, Al-khalidi HR et al (2013) Prevalence and distribution of late gadolinium enhancement in a large population of patients with Duchenne muscular dystrophy: effect of age and left ventricular systolic function. J Cardiovasc Magn Reson. Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Division of CardiologyChildren’s National Health SystemWashington DCUSA
  2. 2.Center for Genetic Medicine ResearchChildren’s National Health SystemWashington DCUSA

Personalised recommendations