Apical-basal hemodynamic force strength and left ventricular global longitudinal strain derived from routine cine CMR independently predicted constrictive physiology in pericarditis, achieving a combined AUC of 0.82.
Observational (n=103)
Blinded to clinical data
No
Does LV strain and hemodynamic forces analysis from routine cine CMR improve the quantitative detection of constrictive physiology in patients with pericarditis?
LV strain and hemodynamic force analysis from routine cine CMR provides accurate, quantitative detection of constrictive physiology in pericarditis without requiring additional specialized imaging sequences.
Odds Ratio: 0.89 (95% CI 0.82–0.97)
p-value: p=0.005
Abstract Objectives Constrictive physiology (CP) may complicate pericarditis and requires timely recognition, yet CMR assessment is largely qualitative. This study evaluated the diagnostic value of cine-based strain and hemodynamic forces (HDF) analysis for distinguishing CP from non-constrictive physiology (NCP). Materials and methods HDF analysis was retrospectively performed on routine 1.5 T cine images from 2008 to 2024 in patients with CMR-confirmed pericarditis. Patients were classified as CP or NCP non-invasively using guideline-defined clinical and imaging criteria. In addition to left ventricular (LV) function, global longitudinal strain (GLS), global circumferential strain (GCS), and HDF parameters (e.g., apical–basal A–B HDF strength) were analyzed. Student’s t -test, binary logistic regression, and receiver operating characteristic analysis were performed. Results Among 103 patients with pericarditis (mean age 53 ± 18 years), 42 (41%) had CP and 61 (59%) had NCP. LV ejection fraction did not differ between groups, whereas LV end-diastolic volume index was reduced in CP (62.0 ± 16.7 mL/m² vs 75.4 ± 18.2, p = 0.003). Strain and HDF parameters were significantly impaired in CP (e.g., A–B HDF strength: 15.3 ± 6.2% vs 21.4 ± 7.3%, p < 0.001). LV GLS and A–B HDF strength achieved good diagnostic performance for detecting CP (area under the curve AUC 0.76 and 0.78, respectively), further enhanced when combined (AUC 0.82). Both were independent predictors of CP on multivariable analysis (odds ratio OR 1.21, p = 0.002; and OR 0.83, p = 0.007, respectively). Conclusions LV strain and HDF analysis using routine CMR cine enabled quantitative detection of CP in pericarditis. A–B HDF strength, particularly in combination with LV GLS, provided the highest diagnostic accuracy. Clinical relevance statement Strain and HDF analysis derived from routine cine CMR enable detection of CP in pericarditis, providing novel quantitative parameters that complement conventional qualitative CMR assessment of CP without additional sequences. Key Points CP may complicate pericarditis and can be addressed by targeted therapy, yet CMR diagnosis remains largely qualitative and challenging. Novel CMR metrics, including LV GLS and apical–basal HDF, showed good diagnostic performance. LV strain and HDF analysis from routine cine CMR cine enabled quantitative detection of CP in pericarditis without additional sequences.
Vollbrecht et al. (2026) conducted an observational in Pericarditis (n=103). Apical-basal hemodynamic force (A-B HDF) strength vs. Non-constrictive physiology was evaluated on Presence of constrictive physiology (CP) (OR 0.89, 95% CI 0.82-0.97, p=0.005). Apical-basal hemodynamic force strength and left ventricular global longitudinal strain derived from routine cine CMR independently predicted constrictive physiology in pericarditis, achieving a combined AUC of 0.82.