Cardiac Magnetic Resonance Imaging in the Evaluation of Functional Impairments in the Right Heart

Figure 1. FTI strain measurements of RV using cMRI tissue-tracking software (cvi42 version 5, Circle Cardiovascular Imaging Inc., Calgary, AB, Canada). (A) FTI with radial strain overlaid on short-axis cine SSFP image. Green circle: epicardium of LV; red circle: endocardium of LV; blue circle: epicardium of RV; yellow circle: endocardium of RV. (B) RV global radial strain. Radial strain values are usually positive. On the graph, the vertical axis shows the radial strain and the horizontal axis shows the time in milliseconds. FTI, feature tracking imaging; RV, right ventricle; LV, left ventricle; cMRI, cardiac magnetic resonance imaging; SSFP, steady-state free precession.

Figure 2. RV in pulmonary hypertension. (A) Dilated pulmonary artery in can be seen in a patient with pulmonary hypertension using short-axis cine cMRI. The arrow is pointing to the dilated pulmonary artery. (B) Pulmonary artery flow, using cMRI phase contrast, can be seen in a patient with pulmonary hypertension. (C) Four-dimensional myocardial FTI on a short-axis cine SSFP image. (D) RV global longitudinal strain in a patient with pulmonary hypertension. Longitudinal values are usually in the negative range. On the graph, the vertical axis shows the longitudinal strain (14.1%) and the horizontal axis shows the time in milliseconds. FTI, feature tracking imaging; RV, right ventricle; cMRI, cardiac magnetic resonance imaging; SSFP, steady-state free precession.

Figure 3. RV in a tetralogy of Fallot. (A) Cine cMRI four-chamber view of a patient with TOF. The RV is mildly dilated and has mild RV hypertrophy. The LV has severe hypertrophy. (B) cMRI, with phase-sensitive inversion recovery and four-chamber view, of a patient with TOF, showing a dilated RV and RA. (C) Planimetry of RV. The RV myocardium’s epicardial (green) and endocardial (red) borders are manually traced at the end-diastole on this short-axis cMRI in a patient with TOF showing increased trabeculation in their right ventricle. (D) RV global radial strain in TOF. Radial strain values are usually positive. On the graph, the vertical axis shows the radial strain and the horizontal axis shows the time in milliseconds. RV, right ventricle; LV, left ventricle; cMRI, cardiac magnetic resonance imaging; TOF, tetralogy of Fallot.

Figure 4. RV in ARVC. (A) cMRI, with phase-sensitive inversion recovery and four-chamber view, of a patient with ARVC, showing severe dilated and hyper trabecular RV and dilated RA. (B) T1 mapping of a five-chamber view of a patient with ARVC, used to assess myocardial extracellular space, showing severe RV hyper trabeculations and dilatation. (C) Short-axis phase-sensitive in-version recovery cMRI view of a patient with ARVC, showing severe RV dilatation. (D) RV global radial strain in a patient with ARVC. Radial strain values are usually positive. On the graph, the vertical axis shows the radial strain and the horizontal axis shows the time in milliseconds. ARVC, arrhythmogenic right ventricular cardiomyopathy; RA, right atrium; RV, right ventricle; cMRI, cardiac magnetic resonance imaging.

Figure 5. RV infarction. (A) Short-axis phase-sensitive inversion recovery, late-phase contrast enhancement cMRI view of a patient with inferolateral LV and RV lateral wall infarction. (B) Two-dimensional myocardial FTI on a short-axis cine SSFP image shows an impaired RV radial strain. Radial strain values are also usually in the positive range. On the graph, the vertical axis shows the radial strain and the horizontal axis shows the time in milliseconds. FTI, feature tracking imaging; LV, left ventricle; RV, right ventricle; cMRI, cardiac magnetic resonance imaging; SSFP, steady-state free precession.

Figure 6. Right atrial strain. (A) RA strain analyzed using cMRI-FTI and a four-chamber cine SSFP image in healthy men. (B) RA radial time–strain curves (purple) measured using feature tracking cMRI show that the RAGLS’s reservoir function is 54%, its conduit is 17.3%, and its boost is 15.7%. FTI, feature tracking imaging; RA, right atrial; RV, right ventricle; RAGLS, right atrial global longitudinal strain; cMRI, cardiac magnetic resonance imaging; SSFP, steady-state free precession.