Left and right ventricular strain using fast strain-encoded cardiovascular magnetic resonance for the diagnostic classification of patients with chronic non-ischemic heart failure due to dilated, hypertrophic cardiomyopathy or cardiac amyloidosis

Figures

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  Fig. 1. Moderate correlations were found between left ventricular (LV) ejection fraction (LVEF) (%) with LV global longitudinal strain (GLS) and global circumferential strain (GCS) and with %normal myocardium for the LV (a–c) and right ventricle (RV) (d–f)

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  Fig. 2. Strain and non-infarct related late gadolinium enhancement (LGE) analysis by segments: Segments of controls showed the highest longitudinal and circumferential strain values, followed by segments of patients with non-ischemic cardiomyopathy without non-infarct related LGE and then by segments of patients with non-ischemic cardiomyopathy with non-infarct related LGE (a, b). For segmental analysis, the standard deviations of mean segmental strain values are provided. The corresponding polar maps of regional strain values in healthy subjects and in segments of patients with non-ischemic cardiomyopathy without and with LGE, as well as logistic regression analysis for the ability of mean longitudinal and circumferential segmental strain to predict the presence of non-infarct related LGE in a given myocardial segment, are provided in c, d

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  Fig. 3. LV-ejection fraction (LVEF) and RV-ejection fraction (RVEF), global circumferential strain (GCS), %normal LV and RV myocardium as well as mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE) significantly decreased with increasing heart failure stage (a–h)

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  Fig. 4. %normal LV myocardium exhibited incremental value for the identification of patients with subclinical LV-dysfunction and for the differentiation of clinical versus subclinical heart failure, surpassing the value of LVEF and MAPSE. All 3 parameters were equal for the identification of patients with refractory stage D heart failure (a–c). %normal RV myocardium exhibited incremental value for the identification of patients with subclinical LV-dysfunction and for the differentiation of clinical versus subclinical heart failure, surpassing the value of RVEF and TAPSE. RVEF exhibited the highest accuracy for the identification of patients with refractory heart failure (d–f)

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  Fig. 5. Logistic regression analysis demonstrated the incremental predictive role of %normal LV (a) and RV (b) myocardium for the identification of patients with subclinical myocardial dysfunction independent of age, NYHA class and LVEF/RVEF

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  Fig. 6. Eleven of 31 (36%) patients at stage A, i.e., at risk for heart failure but with no structural or functional abnormalities where re-classified by %normal LV myocardium to stage B, i.e., subclinical LV-dysfunction. LV-dysfunction was detected by LVEF (threshold = 50%) and %normal LV myocardium (threshold = 80%) in 29/140(21%) and 121/140(86%) of patients with subclinical disease and in 55/105(52%) and 104/105(99%) of patients, respectively with overt heart failure

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  Fig. 7. Bland–Altman plots, exhibiting narrow limits of agreement for global longitudinal strain (GLS) and global circumferential strain (GCS), and for %normal myocardium