Quantitative comparison of two-dimensional and three-dimensional strain measurement using MRI feature tracking in repair Fontan patients and normal child volunteers

Q: What are the key findings of this study?

3D CMR feature-tracking strain detected reduced 3D global circumferential strain in Fontan patients vs healthy children with high reproducibility.

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Functional single ventricle (FSV) after Fontan repair (n=64). Intervention: Fontan circulation assessed by 2D and 3D CMR feature-tracking strain analysis vs. Gender-matched healthy child volunteers (LVEF ≥55%) and 2D vs. 3D CMR feature-tracking strain analysis. Primary outcome: 3D global circumferential strain (GCS) of the dominant ventricle (p=0.003).

Q: What does this research mean for the field?

3D CMR feature-tracking strain detects significantly reduced global circumferential strain in pediatric Fontan patients compared to healthy children (-13.70% vs -18.01%) with high reproducibility. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Liwei Hu; Qian Wang; Gregory P. Barton; Rong Ouyang; Aimin Sun; Chen Guo; Tongtong Han; Yumin Zhong

doi:10.1186/s12880-020-0413-6

January 28, 2020BMC Medical ImagingOpen Access

Quantitative comparison of two-dimensional and three-dimensional strain measurement using MRI feature tracking in repair Fontan patients and normal child volunteers

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Key result

3D CMR feature tracking detects ~4-point lower global circumferential strain in Fontan patients vs healthy controls.

P=0.003
n=64

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Why the study?

The study evaluated the accuracy of 2D and 3D strain analyses by comparing strain and cardiac function parameters between Fontan repair patients and normal child volunteers.

Does 3D cardiac magnetic resonance feature-tracking strain analysis accurately and reproducibly detect abnormal myocardial deformation and correlate with cardiac function compared with 2D strain in pediatric Fontan repair patients versus healthy child volunteers?

Key Points

To evaluate the accuracy and reproducibility of two-dimensional and three-dimensional cardiac magnetic resonance feature-tracking strain parameters compared to conventional cardiac function in Fontan repair patients and healthy child volunteers.
Retrospectively analyzed 32 patients with Fontan circulation (21 left ventricular and 11 right ventricular morphology) and 32 healthy child volunteers using 1.5-Tesla cardiac magnetic resonance imaging.
Quantified 2D and 3D global radial strain (GRS), global circumferential strain (GCS), and global longitudinal strain (GLS) of the dominant ventricle using feature tracking, assessing observer variability with intraclass correlation coefficients.
Fontan repair patients exhibited significantly lower 3D GRS (36.35 ± 16.72 vs. 44.96 ± 9.98; p = 0.010), 3D GLS (-8.86 ± 6.84 vs. -13.67 ± 2.44; p < 0.001), and 3D GCS (-13.70 ± 7.84 vs. -18.01 ± 1.78; p = 0.003), whereas 2D analyses only significantly differed for GLS (-16.49 ± 5.00 vs. -19.49 ± 2.03; p = 0.002).
In the Fontan group, 3D GCS correlated significantly with ejection fraction (r = -0.491, p = 0.004), indexed end-diastolic volume (r = 0.523, p = 0.002), and indexed end-systolic volume (r = 0.602, p < 0.001).
Three-dimensional strain showed superior reproducibility over 2D strain, with 3D GCS demonstrating the highest inter-observer agreement (ICC = 0.87, CoV = 5.15), followed by 3D GLS (ICC = 0.84, CoV = 5.36).

Study Design

Type

Case-Control (n=64)

Blinding

Readers blinded to patient demographic data; second observer blinded to results of first observer

Multicenter

No

Structured PICO

Does 3D cardiac magnetic resonance feature-tracking strain analysis accurately and reproducibly detect abnormal myocardial deformation and correlate with cardiac function compared with 2D strain in pediatric Fontan repair patients versus healthy child volunteers?

P

Population

64 pediatric participants (32 Fontan repair patients, mean age 9.5 years, and 32 healthy gender-matched child volunteers, mean age 13.12 years; 65.6% male overall) undergoing clinical 1.5-Tesla cardiac MRI at a average 5.06-year post-surgery follow-up.

E

Exposure

3D and 2D global and regional myocardial strain analysis (radial [GRS], circumferential [GCS], longitudinal [GLS]) of the dominant ventricle using 1.5-Tesla cardiac magnetic resonance feature-tracking (CMR-FT) on routine balanced steady-state free precession (b-SSFP) cine images

C

Comparator

Gender-matched healthy child volunteers (n=32) with no history of cardiac disease and LVEF ≥55% confirmed by echocardiography; comparison between 2D and 3D CMR feature-tracking strain modalities

O

Outcome

2D and 3D global radial strain (GRS), global circumferential strain (GCS), and global longitudinal strain (GLS) differences between Fontan patients and controls, correlations with conventional cardiac function parameters (EF, indexed EDV, indexed ESV), and intra-/inter-observer reproducibility (ICC and CoV)surrogate

Main Result

Absolute Event Rate: -13.7% vs -18.01%

p-value: p=0.003

3D global circumferential strain via CMR feature-tracking is feasible, highly reproducible, and detects subtle myocardial dysfunction in pediatric Fontan patients even when conventional ejection fraction and 2D circumferential/radial strain appear preserved.

Limitations

Single-center design
Retrospective nature limiting the population to those clinically referred for CMR, allowing for potential selection bias
Three-chamber view was not included in SSFP cine image acquisition due to acquisition time limitations, affecting 2D and 3D strain analysis
3D images presented substantially lower spatial and temporal resolution than 2D counterparts
Strain rate analysis was not included due to lower temporal resolution of CMR cine images
Retrospective study design limited to patients clinically referred for CMR, introducing potential selection bias
Three-chamber view was not included due to acquisition time limitations, affecting 2D and 3D strain analysis
Lower spatial and temporal resolution in 3D images compared to 2D counterparts
Lack of strain rate analysis due to insufficient temporal resolution of CMR cine images for children

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Implication

Supports 3D CMR GCS for detecting subclinical dysfunction in Fontan patients; leaves open prospective validation before clinical adoption.

Abstract

BACKGROUND: The accuracy of 2D and 3D strain analyses was evaluated by comparing strain and cardiac function parameters in Fontan repair patients and normal child volunteers. METHODS: We retrospectively enrolled 32 patients with Fontan circulation and 32 child volunteers who had undergone clinical cardiac magnetic resonance (CMR) assessment of the dominant ventricle with a 1.5-Tesla MRI scanner. Global and regional strain (2D and 3D) of the dominant ventricle in both groups was assessed using CMR feature-tracking. Correlations between cardiac function and strain data were assessed using Pearson's correlation coefficient values. The intraclass correlation coefficient (ICC) and coefficient of variation (CoV) were determined to evaluate repeatability and agreement. RESULTS: The 2D GLS showed significant differences between the Fontan repair patients and volunteers (- 16.49 ± 5.00 vs. -19.49 ± 2.03; p = 0.002). The 2D GRS and 2D GCS showed no significant differences between two groups. 2D GRS: 38.96 ± 14.48 vs. 37.46 ± 7.77; 2D GCS: - 17.64 ± 5.00 vs. -16.89 ± 2.96, respectively; p > 0.05). The 3D global radial strain (GRS), global circumferential strain (GCS), and global longitudinal strain (GLS) showed significant differences between the Fontan repair patients and volunteers (3D GRS: 36.35 ± 16.72 vs. 44.96 ± 9.98; 3D GLS: - 8.86 ± 6.84 vs. -13.67 ± 2.44; 3D GCS: - 13.70 ± 7.84 vs. -18.01 ± 1.78; p < 0.05, respectively). The ejection fraction (EF) and 3D GCS were significantly associated (r = - 0.491, p = 0.004). The 3D GCS showed correlations with the indexed end-diastolic volume (EDV) (r = 0.523, p = 0.002) and indexed end-systolic volume (ESV) (r = 0.602, p < 0.001). 3D strain showed good reproducibility, with GCS showing the best inter-observer agreement (ICC = 0.87 and CoV = 5.15), followed by GLS (ICC = 0.84 and CoV = 5.36). CONCLUSIONS: 3D GCS is feasible, highly reproducible, and strongly correlated with conventional cardiac function measures. 3D GCS assessments may be useful for monitoring abnormal myocardial motion in patients with Fontan circulation.

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Cite This Study

Hu et al. (2020) conducted a case-control in Functional single ventricle (FSV) after Fontan repair (n=64). Fontan circulation assessed by 2D and 3D CMR feature-tracking strain analysis vs. Gender-matched healthy child volunteers (LVEF ≥55%) and 2D vs. 3D CMR feature-tracking strain analysis was evaluated on 3D global circumferential strain (GCS) of the dominant ventricle (p=0.003). 3D CMR feature-tracking strain detected reduced 3D global circumferential strain in Fontan patients vs healthy children with high reproducibility.

synapsesocial.com/papers/6a75173a9c92392688b1fe45 https://doi.org/10.1186/s12880-020-0413-6

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Quantitative comparison of two-dimensional and three-dimensional strain measurement using MRI feature tracking in repair Fontan patients and normal child volunteers

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Quantitative comparison of two-dimensional and three-dimensional strain measurement using MRI feature tracking in repair Fontan patients and normal child volunteers

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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