What does this research mean for the field?

Transverse strain (TrS) shows high reproducibility (ICC > 0.75) and strong intermethod agreement with global longitudinal strain in patients with congenital heart disease. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to evaluate the feasibility and reproducibility of transverse strain measurements in congenital heart disease and compare them to global longitudinal strain.

February 8, 2026Open Access

Strain Analysis from Transverse CMR Cine Imaging in Congenital Heart Disease: Feasibility, Reproducibility, and Comparison to Global Longitudinal Strain

Key Result

Transverse strain from transverse CMR cine images is feasible, reproducible (ICC >0.75), and strongly agrees with global longitudinal strain in Fontan and ToF right ventricles.

Key Points

This research aims to evaluate the feasibility and reproducibility of transverse strain measurements in congenital heart disease and compare them to global longitudinal strain.
Retrospective analysis of CMR cine images from 40 congenital heart disease patients and 10 healthy controls.
Measurements for both global longitudinal strain and transverse strain were conducted.
Statistical analysis included intra- and interobserver reproducibility and intermethod agreement.
Transverse strain showed high intra- and interobserver reproducibility with ICC > 0.75.
There was strong intermethod agreement between transverse strain and global longitudinal strain, especially in Fontan patients.
Positive bias was noted in transverse strain measurements for the left ventricle in Tetralogy of Fallot patients and in healthy controls.

Structured PICO

Does transverse strain (TrS) from CMR cine imaging provide feasible, reproducible, and comparable measurements to standard global longitudinal strain (GLS) in patients with congenital heart disease?

Population

40 patients with complex congenital heart disease (n=20 Fontan, n=20 Tetralogy of Fallot) and 10 healthy controls

Intervention

Strain measurements derived from transverse-oriented CMR cine images (Transverse Strain [TrS])

Comparator

Standard Global Longitudinal Strain (GLS) derived from long-axis cine images

Outcome

Feasibility, intra- and interobserver reproducibility of TrS, and intermethod agreement between TrS and GLSsurrogate

Transverse strain from CMR cine imaging is a feasible and reproducible alternative to standard global longitudinal strain, particularly in patients with univentricular physiology and Tetralogy of Fallot.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background: Global longitudinal strain (GLS), derived from long-axis cine images (LAX), is a sensitive marker for myocardial dysfunction and a strong predictor for clinical events and future ventricular deterioration. In patients with complex congenital heart disease (CHD) transverse-oriented cine imaging is part of the standard cardiac magnetic resonance (CMR) protocol. We aimed to study the feasibility and reproducibility of strain measurements derived from transverse-oriented cine images (Transverse Strain (TrS)) and compare them with standard GLS. Methods: We retrospectively analyzed CMR cine images from 40 patients (n = 20 Fontan, n = 20 Tetralogy of Fallot (ToF)) and 10 healthy controls. Strain analysis was performed in every subject using both the conventional GLS and the TrS approach. Results: TrS showed high intra- and interobserver reproducibility in patients with CHD (intraclass correlation coefficient (ICC) > 0.75, p 0.75) but showed a positive bias for TrS in the left ventricle (LV) of ToF patients (mean difference = 5.03) and in both ventricles of healthy controls (mean difference LV = 5.36, RV = 4.01). Conclusions: TrS is feasible and reproducible and may offer a new methodological approach for strain assessment, especially in CHD patients with univentricular physiology and ToF patients. Further studies are needed to validate this new approach and perform correlations to clinical outcomes.

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