Biventricular myocardial strain analysis using cardiac magnetic resonance feature tracking (CMR-FT) in patients with distinct types of right ventricular diseases comparing arrhythmogenic right ventricular cardiomyopathy (ARVC), right ventricular outflow-tract tachycardia (RVOT-VT), and Brugada syndrome (BrS)
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As underlying heart diseases of right ventricular tachyarrhythmias, ARVC causes wall-motion abnormalities based on fibrofatty myocardial degeneration, while RVOT-VT and BrS are thought to lack phenotypic MR characteristics. To examine whether cardiac magnetic resonance (CMR) feature tracking (FT) in addition to ARVC objectively facilitates detection of myocardial functional impairments in RVOT-VT and BrS.
Cine MR datasets of four retrospectively enrolled, age-matched study groups [n = 65; 16 ARVC, 26 RVOT-VT, 9 BrS, 14 healthy volunteers (HV)] were independently assessed by two distinctly experienced investigators regarding myocardial function using CMR-FT. Global strain (%) and strainrate (s−1) in radial and longitudinal orientation were assessed at RVOT as well as for left (LV) and right (RV) ventricle at a basal, medial and apical section with the addition of a biventricular circumferential orientation.
RV longitudinal and radial basal strain (%) in ARVC (− 12.9 ± 4.2; 11.4 ± 5.1) were significantly impaired compared to RVOT-VT (− 18.0 ± 2.5, p ≤ 0.005; 16.4 ± 5.2, p ≤ 0.05). Synergistically, RVOT endocardial radial strain (%) in ARVC (33.8 ± 22.7) was significantly lower (p ≤ 0.05) than in RVOT-VT (54.3 ± 14.5). For differentiation against BrS, RV basal and medial radial strain values (%) (13.3 ± 6.1; 11.8 ± 2.9) were significantly reduced when compared to HV (21.0 ± 6.9, p ≤ 0.05; 20.1 ± 6.6, p ≤ 0.005), even in case of a normal RV ejection fraction (EF) (> 45%; n = 6) (12.0 ± 2.7 vs. 20.1 ± 6.6, p ≤ 0.05).
CMR-FT facilitates relevant differentiation in patients with right ventricular tachyarrhythmias: between ARVC against RVOT-VT and HV as well as between BrS with even a preserved EF against HV.
KeywordsFeature tracking (FT) Myocardial strain analysis Arrhythmogenic right ventricular cardiomyopathy (ARVC) Brugada syndrome (BrS) Right ventricular outflow tract tachycardia (RVOT-VT)
Arrhythmogenic right ventricular cardiomyopathy
Area under curve
Cardiac magnetic resonance
Left ventricle left ventricular
Left ventricular end diastolic volume index
Left ventricular ejection fraction
Left ventricular end systolic volume index
Receiver operating curve
Right ventricle/right ventricular
Right ventricular end diastolic volume index
Right ventricular ejection fraction
Right ventricular end systolic volume index
Right ventricular outflow tract
Right ventricular outflow tract tachycardia
Sudden cardiac death
Ion channel mutation in Brugada syndrome
Task Force Score
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WH, ESB and PH initiated the study concept. PH is the corresponding author of the manuscript. PH and HF participated in the myocardial strain analysis. PH and CS participated in the statistical analysis and PH and CS drafted the manuscript. WH, ESB, MP, HF, MK and PS contributed valuable comments and formulations. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Institutional Review Board approval was obtained. The current study obtained approval and consent from the local ethics committee (ethics commission of the medical association Westfalen-Lippe and the medical faculty of the Westfälische-Wilhelms-University (WWU) Muenster; reference number: 2013-632-f-N).
Written informed consent was obtained from all subjects (patients) prior to their inclusion in the study.
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