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Comparison of Strain-Encoding and Feature-Tracking Derived Myocardial Deformation Assessment of Left Ventricular Function in a Pediatric and Adult Congenital Heart Disease Cohort

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Abstract

Background

Cardiac magnetic resonance (CMR) strain can be assessed with feature-tracking (FT), which utilizes a post-processing algorithm to quantify myocardial deformation on routine cine images, and strain-encoding magnetic resonance imaging (SENC), which uses parallel magnetization tags combined with out-of-plane phase-encoding gradients to quantify deformation. Assessing agreement is critical to determine whether results can be translated between methods. We compared SENC to FT in the assessment of left ventricle (LV) global longitudinal strain (GLS) and global circumferential strain (GCS) in a cohort of pediatric and adult congenital heart disease (ACHD) patients.

Methods

Pediatric subjects and ACHD patients underwent CMR on 1.5 T Siemens scanners, including balanced steady-state-free precession (bSSFP) cine imaging and SENC acquisitions in apical two and four chamber, left ventricular outflow tract, and short axis views. bSSFP cine imaging FT analysis was completed with Medis QStrain. Myocardial Solutions MyoStrain was used to analyze SENC. Correlation was assessed by Spearman’s rank correlation coefficient. Agreement between techniques was assessed with concordance correlation coefficient (CCC) and Bland–Altman.

Results

The cohort included 134 patients, 75 with congenital heart disease (56%). The median age was 16.3 years (IQR 13.7, 19.5). Median LV ejection fraction was 57% (IQR 54.4, 61.6). SENC and FT were in poor agreement for GLS (Spearman’s ρ = 0.58, p < 0.001; CCC 0.24) and GCS (Spearman’s ρ = 0.29, p < 0.001; CCC 0.03).

Conclusion

There was poor agreement between SENC and FT derived GLS and GCS in a cohort of pediatric and ACHD patients, suggesting that SENC and FT cannot be used interchangeably.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code Availability

Not applicable.

Abbreviations

ACHD:

Adult congenital heart disease

A2C:

Apical two chamber

A4C:

Apical four chamber

bSSFP:

Balanced steady-state-free precession pulse sequence

CMR:

Cardiac magnetic resonance

DENSE:

Displacement-tracking with stimulated echoes

EDV:

End diastolic volume

ESV:

End systolic volume

EF:

Ejection fraction

FT:

Feature-tracking

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

HARP:

Harmonic phase magnetic resonance

LGE:

Late gadolinium enhancement

LV:

Left ventricle

LVOT:

Left ventricular outflow tract

PSIR:

Phase-sensitive inversion recovery

SAX:

Short axis

SENC:

Strain-encoding magnetic resonance imaging

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Acknowledgements

We thank the cardiac magnetic resonance technologists, Shannon Bozeman and Dana Fuhs, for their efforts in implementing the SENC sequences and continuously optimizing the acquisition of images. We also thank Nael Osman and Amanda Rice with Myocardial Solutions for providing education on the use of SENC imaging and their support of this study.

Funding

This work was supported by CTSA award No. UL1 TR002243 from the National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children’s Way, Suite 5230, Doctor’s Office Tower, Nashville, TN, 37232, USA

    Joshua D. Chew, Kristen George-Durrett, Benjamin Acheampong, Jeffrey G. Weiner, David A. Parra & Jonathan H. Soslow

  2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    James C. Slaughter

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  1. Joshua D. Chew
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Contributions

JDC contributed to the conception and design of the study, acquisition, analysis and interpretation of data, and primarily drafted the manuscript. KGD, BA, and JGW contributed to the acquisition and analysis of data. JCS contributed to the analysis and interpretation of data. DP contributed to the acquisition and analysis of data and substantively revised the manuscript. JHS contributed to the conception and design of the study, acquisition, analysis and interpretation of data, and substantively revised the manuscript. All authors read, critically reviewed and approved the final manuscript.

Corresponding author

Correspondence to Joshua D. Chew.

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Conflict of interest

The authors declare that they have no competing interests. Myocardial solutions provided analysis software but had no input into design of study, analysis, or interpretation.

Ethical Approval

The study was approved by the Vanderbilt University Medical Center Institutional Review Board (IRB #161524).

Consent to Participate

For all pediatric subjects, guardians provided informed consent and the subject provided assent. All adult subjects provided informed consent.

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Not applicable.

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Chew, J.D., George-Durrett, K., Acheampong, B. et al. Comparison of Strain-Encoding and Feature-Tracking Derived Myocardial Deformation Assessment of Left Ventricular Function in a Pediatric and Adult Congenital Heart Disease Cohort. Pediatr Cardiol 43, 1338–1348 (2022). https://doi.org/10.1007/s00246-022-02856-6

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  • DOI: https://doi.org/10.1007/s00246-022-02856-6

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