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      Assessment of Global Longitudinal and Circumferential Strain Using Computed Tomography Feature Tracking: Intra-Individual Comparison with CMR Feature Tracking and Myocardial Tagging in Patients with Severe Aortic Stenosis

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          Abstract

          In this study, we used a single commercially available software solution to assess global longitudinal (GLS) and global circumferential strain (GCS) using cardiac computed tomography (CT) and cardiac magnetic resonance (CMR) feature tracking (FT). We compared agreement and reproducibility between these two methods and the reference standard, CMR tagging (TAG). Twenty-seven patients with severe aortic stenosis underwent CMR and cardiac CT examinations. FT analysis was performed using Medis suite version 3.0 (Leiden, The Netherlands) software. Segment (Medviso) software was used for GCS assessment from tagged images. There was a trend towards the underestimation of GLS by CT-FT when compared to CMR-FT (19.4 ± 5.04 vs. 22.40 ± 5.69, respectively; p = 0.065). GCS values between TAG, CT-FT, and CMR-FT were similar ( p = 0.233). CMR-FT and CT-FT correlated closely for GLS ( r = 0.686, p < 0.001) and GCS ( r = 0.707, p < 0.001), while both of these methods correlated moderately with TAG for GCS ( r = 0.479, p < 0.001 for CMR-FT vs. TAG; r = 0.548 for CT-FT vs. TAG). Intraobserver and interobserver agreement was excellent in all techniques. Our findings show that, in elderly patients with severe aortic stenosis (AS), the FT algorithm performs equally well in CMR and cardiac CT datasets for the assessment of GLS and GCS, both in terms of reproducibility and agreement with the gold standard, TAG.

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          Strain imaging using cardiac magnetic resonance

          The objective assessments of left ventricular (LV) and right ventricular (RV) ejection fractions (EFs) are the main important tasks of routine cardiovascular magnetic resonance (CMR). Over the years, CMR has emerged as the reference standard for the evaluation of biventricular morphology and function. However, changes in EF may occur in the late stages of the majority of cardiac diseases, and being a measure of global function, it has limited sensitivity for identifying regional myocardial impairment. On the other hand, current wall motion evaluation is done on a subjective basis and subjective, qualitative analysis has a substantial error rate. In an attempt to better quantify global and regional LV function; several techniques, to assess myocardial deformation, have been developed, over the past years. The aim of this review is to provide a comprehensive compendium of all the CMR techniques to assess myocardial deformation parameters as well as the application in different clinical scenarios.
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            Inter-study reproducibility of cardiovascular magnetic resonance myocardial feature tracking

            Background Cardiovascular magnetic resonance myocardial feature tracking (CMR-FT) is a recently described method of post processing routine cine acquisitions which aims to provide quantitative measurements of circumferentially and radially directed ventricular wall strain. Inter-study reproducibility is important for serial assessments however has not been defined for CMR-FT. Methods 16 healthy volunteers were imaged 3 times within a single day. The first examination was performed at 0900 after fasting and was immediately followed by the second. The third, non-fasting scan, was performed at 1400. CMR-FT measures of segmental and global strain parameters were calculated. Left ventricular (LV) circumferential and radial strain were determined in the short axis orientation (EccSAX and ErrSAX respectively). LV and right ventricular longitudinal strain and LV radial strain were determined from the 4-chamber orientation (EllLV, EllRV, and ErrLAX respectively). LV volumes and function were also analysed. Inter-study reproducibility and study sample sizes required to demonstrate 5% changes in absolute strain were determined by comparison of the first and second exams. The third exam was used to determine whether diurnal variation affected reproducibility. Results CMR-FT strain analysis inter-study reproducibility was variable. Global strain assessment was more reproducible than segmental analysis. Overall EccSAX was the most reproducible measure of strain: coefficient of variation (CV) 38% and 20.3% and intraclass correlation coefficient (ICC) 0.68 (0.55-0.78) and 0.7 (0.32-0.89) for segmental and global analysis respectively. The least reproducible segmental measure was EllRV: CV 60% and ICC 0.56 (0.41-0.69) whilst the least reproducible global measure was ErrLAX: CV 33.3% and ICC 0.44 (0–0.77). Variable reproducibility was also reflected in the calculated sample sizes, which ranged from 11 (global EccSAX) to 156 subjects (segmental EllRV). The reproducibility of LV volumes and function was excellent. There was no diurnal variation in global strain or LV volumetric measurements. Conclusions Inter-study reproducibility of CMR-FT varied between different parameters, as summarized above and was better for global rather than segmental analysis. It was not measurably affected by diurnal variation. CMR-FT may have potential for quantitative wall motion analysis with applications in patient management and clinical trials. However, inter-study reproducibility was relatively poor for segmental and long axis analyses of strain, which have yet to be validated, and may benefit from further development.
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              Echo Parameters for Differential Diagnosis in Cardiac Amyloidosis: A Head-to-Head Comparison of Deformation and Nondeformation Parameters.

              A plethora of echo parameters has been suggested for distinguishing cardiac amyloidosis (CA) from other causes of myocardial thickening with, however, scarce data on their head-to-head comparison. This study aimed at comparing the diagnostic accuracy of various deformation and conventional echo parameters in differentiating CA from other hypertrophic substrates, especially in the gray zone of mild hypertrophy (maximum wall thickness ≤16 mm) or normal ejection fraction (EF).
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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                10 September 2019
                September 2019
                : 8
                : 9
                : 1423
                Affiliations
                [1 ]Department of Internal Medicine/Cardiology, German Heart Center Berlin, 13353 Berlin, Germany
                [2 ]Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
                [3 ]Philips Healthcare, 22335 Hamburg, Germany
                [4 ]Klinik für Kardiologie und Internistische Intesivmedizin, Krankenhaus der Augustinerinnen, 50678 Köln, Germany
                [5 ]DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
                [6 ]Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, 13353 Berlin, Germany
                [7 ]Department of Cardiothoracic Surgery, German Heart Center Berlin, 13353 Berlin, Germany
                [8 ]Department of Engineering and Architecture, University of Trieste, 34127 Trieste, Italy
                Author notes
                [* ]Correspondence: kelle@ 123456dhzb.de ; Tel.: +49-30-4593-1182
                [†]

                Both authors contributted equally.

                Author information
                https://orcid.org/0000-0001-7726-6948
                https://orcid.org/0000-0003-2886-7653
                Article
                jcm-08-01423
                10.3390/jcm8091423
                6780556
                31509951
                4bce2bda-c941-4813-aeb5-192dcdb9845b
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 26 July 2019
                : 05 September 2019
                Categories
                Article

                systemic disease,cardiac computed tomography,cardiac magnetic resonance,feature tracking,tagging,myocardial deformation,strain

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