January 1, 2020Open Access

Cardiovascular magnetic resonance feature tracking for characterization of patients with heart failure with preserved ejection fraction: correlation of global longitudinal strain with invasive diastolic functional indices

Structured PICO

Does global longitudinal strain measured by cardiovascular magnetic resonance feature tracking correlate with invasive indices of diastolic dysfunction in patients with HFpEF?

Population

36 subjects: 18 patients with heart failure with preserved ejection fraction (HFpEF) (LVEF ≥50%, NYHA class ≥II, E/e′ > 8 or average e′ < 9 cm/s, BNP > 35 pg/mL; mean age 65 ± 17 years, 16.7% male) and 18 age- and sex-matched healthy control subjects (mean age 61 ± 14 years, 38.9% male). Key exclusions: coronary artery disease, acute coronary syndrome, prior myocardial infarction, greater than moderate valvular disease, hypertrophic obstructive cardiomyopathy, sarcoidosis, amyloidosis, persistent atrial fibrillation, eGFR < 30 mL/min/1.73 m2.

Intervention

Cardiovascular magnetic resonance feature tracking (CMR-FT) to measure global longitudinal strain (GLS) and extracellular volume fraction (ECV), alongside invasive pressure-volume loop assessment via conductance catheter to measure the time constant of active LV relaxation (Tau).

Comparator

Age- and sex-matched healthy control subjects (for comparison of CMR parameters).

Outcome

Correlation between global longitudinal strain (GLS) measured by CMR-FT and the time constant of active LV relaxation (Tau) measured by invasive diastolic functional indices.surrogate

CMR feature tracking-derived global longitudinal strain independently predicts invasive measures of abnormal LV relaxation (Tau) in patients with HFpEF, offering a noninvasive tool to evaluate diastolic dysfunction.

Abstract

BACKGROUND: Left ventricular (LV) diastolic dysfunction is the main cause of heart failure with preserved ejection fraction (HFpEF), and is characterized by LV stiffness and relaxation. Abnormal LV global longitudinal strain (GLS) is frequently observed l in HFpEF, and was shown to be useful in identifying HFpEF patients at high risk for a cardiovascular event. Cardiovascular magnetic resonance (CMR) feature tracking (CMR-FT) enables the reproducible and non-invasive assessment of global strain from cine CMR images. However, the association between GLS and invasively measured parameters of diastolic function has not been investigated. We sought to determine the prevalence and severity of GLS impairment in patients with HFpEF by using CMR-FT, and to evaluate the correlation between GLS measured by CMR-FT and that measured by invasive diastolic functional indices. METHODS: Eighteen patients with HFpEF and 18 age- and sex-matched healthy control subjects were studied. All subjects underwent cine, pre- and post-contrast T1 mapping and late gadolinium-enhancement CMR. In the HFpEF patients, invasive pressure-volume loops were obtained to evaluate LV diastolic properties. GLS was quantified from cine CMR, and extracellular volume fraction (ECV) was quantified from pre- and post-contrast T1 mapping as a known imaging biomarker for predicting LV stiffness. RESULTS: GLS was significantly impaired in patients with HFpEF (- 14.8 ± 3.3 vs.-19.5 ± 2.8%, p < 0.001). Thirty nine percent (7/18) of HFpEF patients showed impaired GLS with a cut-off of - 13.9%. Statistically significant difference was found in ECV between HFpEF patients and controls (32.2 ± 3.8% vs. 29.9 ± 2.6%, p = 0.044). In HFpEF patients, the time constant of active LV relaxation (Tau) was strongly correlated with GLS (r = 0.817, p < 0.001), global circumferential strain (GCS) (r = 0.539, p = 0.021) and global radial strain (GRS) (r = - 0.552, p = 0.017). Multiple linear regression analysis revealed GLS as the only independent predictor of altered Tau (beta = 0.817, p < 0.001) among age, LV end-diastolic volume index, LV end-systolic volume index, LV mass index, GCS, GRS and GLS. CONCLUSIONS: CMR-FT is a noninvasive approach that enables identification of the subgroup of HFpEF patients with impaired GLS. CMR LV GLS independently predicts abnormal invasive LV relaxation index Tau measurements in HFpEF patients. These findings suggest that feature-tracking CMR analysis in conjunction with ECV, may enable evaluation of diastolic dysfunction in patients with HFpEF.

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