Key result
Female sex and increasing age linked to greater ventricular strain in adults free of CVD.
Why the study?
Myocardial deformation measured by myocardial strain is an important marker of cardiovascular disease, motivating the need to establish normal values and evaluate age- and sex-differences using FT-CMR in adults free of CVD in the community.
What are the normal reference values and age- and sex-differences for LV and RV strain measured by FT-CMR in adults without cardiovascular disease?
Observational (n=903)
What are the normal reference values and age- and sex-differences for LV and RV strain measured by FT-CMR in adults without cardiovascular disease?
p-value: p=<0.005
FT-CMR reference values for LV and RV strain in healthy adults demonstrate that women have greater magnitude strain than men, with age-related increases in circumferential and radial strain observed exclusively in women.
May inform sex-specific FT-CMR strain interpretation in healthy adults; leaves open outcome validation before clinical adoption.
BACKGROUND: Myocardial deformation measured by myocardial strain is an important marker of cardiovascular disease (CVD). We aimed to establish normal values and examine age- and sex-differences in left and right ventricular (LV, RV) strain using feature tracking cardiovascular resonance (FT-CMR) in adults free of CVD in the community. METHODS: Framingham Heart Study Offspring participants without CVD, hypertension, or diabetes completed CMR (1.5T) (n=903, 59% (533/903) women, 36-88 years of age). Global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS, respectively) were measured by semi-automated LV and RV myocardial segmentation of short-axis, 2-chamber, and 4-chamber images with cvi42 (v.5.13, Circle Cardiovascular Imaging, Calgary, Canada). RESULTS: Mean LV GLS, GCS, and GRS were -17.8±2.5%, -19.7±2.4%, and 34.9±6.9%, respectively; RV GLS, GCS, and GRS were -20.4±4.0%, -11.7±3.5%, and 19.1±6.5%, respectively. All strain values were of greater magnitude in women than men (all p<0.005). LV and RV GCS and GRS were of greater magnitude (more negative and more positive, respectively) with increasing age (all p<0.001), but GLS was not associated with age. Stratified analysis by sex showed LV and RV GCS and GRS were greater in magnitude with increasing age in women (all p<0.001), whereas no age associations in men were observed. CONCLUSION: We provide FT-CMR reference values for LV and RV strain in a large, community-dwelling U.S. adult cohort free of CVD and CVD risk factors. Women demonstrated greater magnitude LV and RV GCS and GRS with increasing age. The clinical implications of sex-differences in ventricular strain and mechanical remodeling with age deserve further study.
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Pillai et al. (2025) conducted an observational in Healthy adults (free of cardiovascular disease or risk factors) (n=903). Age and sex was evaluated on Left and right ventricular (LV, RV) strain (GLS, GCS, GRS) (p=<0.005). Female sex and increasing age were associated with greater magnitude of ventricular strain in adults free of CVD (P<0.005 for sex differences; P<0.001 for age associations in women).
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