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Normative healthy reference values for global and segmental 3D principal and geometry dependent strain from cine cardiac magnetic resonance imaging

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Abstract

3-Dimensional (3D) myocardial deformation analysis (3D-MDA) enables novel descriptions of geometry-independent principal strain (PS). Applied to routine 2D cine cardiovascular magnetic resonance (CMR), this provides unique measures of myocardial biomechanics for disease diagnosis and prognostication. However, healthy reference values remain undefined. This study describes age- and sex-stratified reference values from CMR-based 3D-MDA, including 3D PS. One hundred healthy volunteers were prospectively recruited following institutional ethics approval and underwent CMR imaging. 3D-MDA was performed using validated software. Age- and sex-stratified global and segmental strain measures were derived for conventional geometry-dependent [circumferential (CS), longitudinal (LS), and radial (RS)] and geometry-independent [minimum (minPS) and maximum principal (maxPS)] directions of deformation. Layer-specific contraction angle interactions were determined using local minPS vectors. The average age was 43 ± 15 years and 55% were women. Strain measures were higher in women versus men. 3D PS-based assessment of maximum tissue shortening (minPS) and maximum tissue thickening (maxPS) were greater than corresponding geometry-dependent markers of LS and RS, consistent with improved representation of local tissue deformations. Global maxPS amplitude best discriminated both age and sex. Segmental analyses showed greater strain amplitudes in apical segments. Transmural PS contraction angles were higher in females and showed a heterogeneous distribution across segments. In this study we provided age and sex-based reference values for 3D strain from CMR imaging, demonstrating improved capacity for 3D PS to document maximal local tissue deformations and to discriminate age and sex phenotypes. Novel markers of layer-specific strain angles from 3D PS were also described.

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Abbreviations

2D:

Two-dimensional

3D MDA:

Three-dimensional myocardial deformation analysis

AHA:

American Heart Association

ANOVA:

Analysis of variance

BMI:

Body mass index

CMR:

Cardiac magnetic resonance imaging

DSR:

Diastolic strain rate

EF:

Ejection fraction

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

GRS:

Global radial strain

LV:

Left ventricle

maxPS:

Maximum principal strain

minPS:

Minimum principal strain

RV:

Right ventricle

SSR:

Systolic strain rate

TRIBECA:

Transmural interplay between contraction angles

TTP:

Time to peak

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Acknowledgements

The authors thank Dr. Gianni Pedrizzetti for his assistance with the graphical representation of principal directions.

Funding

This study was funded in part by the Canadian Institutes for Health Research (CIHR, Project# 10020327).

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Author notes

  1. David G. Guzzardi and James A. White have contributed equally to this manuscript.

Authors and Affiliations

  1. Stephenson Cardiac Imaging Centre, Calgary, AB, Canada

    David G. Guzzardi, James A. White, Dina Labib, Jacqueline Flewitt, Patricia Feuchter, Rosa Sandonato, Andrew G. Howarth, Carmen P. Lydell & Alessandro Satriano

  2. Division of Cardiology, School of Medicine, University of Calgary, Calgary, AB, Canada

    James A. White, Steven Dykstra, Jacqueline Flewitt & Andrew G. Howarth

  3. Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada

    James A. White & Carmen P. Lydell

  4. Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada

    James A. White, Jacqueline Flewitt, Andrew G. Howarth, Carmen P. Lydell & Nowell M. Fine

  5. Alberta Machine Learning Institute, Edmonton, AB, Canada

    Russel Greiner

  6. Foothills Medical Centre, Suite 0700, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada

    Alessandro Satriano

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  1. David G. Guzzardi
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Contributions

AS and JAW contributed to conception and design of the study. AS is developer of the 3D MDA software. DG contributed to data analysis and writing the manuscript. DL performed 3D MDA analysis. SD contributed to data analysis. JF provided study coordination. PF performed MR scans. RS contributed to recruitment. AGH, CPL, NMF, and RG contributed to critical manuscript revision. All authors provided approval for publication of the manuscript.

Corresponding author

Correspondence to Alessandro Satriano.

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Competing interest

JAW receives research support from Siemens Healthineers, Circle Cardiovascular Inc, and Pfizer Inc. and is chief medical officer and a shareholder of Cohesic Inc. AGH is a shareholder of Cohesic Inc. AS is a shareholder in and receives consulting fees from Vitaa Medical Solutions Inc.

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Not applicable.

Ethical approval and consent to participate

The study design was approved by the Conjoint Health Research Ethics Board at the University of Calgary and all subjects provided written informed consent. All research activities were performed in accordance with the Declaration of Helsinki.

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Guzzardi, D.G., White, J.A., Labib, D. et al. Normative healthy reference values for global and segmental 3D principal and geometry dependent strain from cine cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 39, 115–134 (2023). https://doi.org/10.1007/s10554-022-02693-x

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