Integration of longitudinal and circumferential strain predicts volumetric change across the cardiac cycle and differentiates patients along the heart failure continuum.

Oct 02, 2023

Experts: T Jake Samuel,Andrew P Oneglia,Daisha J Cipher,Justin A Ezekowitz,Jason R B Dyck,Todd Anderson,Jonathan G Howlett,D Ian Paterson,Richard B Thompson,Michael D Nelson

Left ventricular (LV) circumferential and longitudinal strain provide important insight into LV mechanics and function, each contributing to volumetric changes throughout the cardiac cycle. We sought to explore this strain-volume relationship in more detail, by mathematically integrating circumferential and longitudinal strain and strain rate to predict LV volume and volumetric rates of change.
Cardiac magnetic resonance (CMR) imaging from 229 participants from the Alberta HEART Study (46 healthy controls, 77 individuals at risk for developing heart failure [HF], 70 patients with diagnosed HF with preserved ejection fraction [HFpEF], and 36 patients with diagnosed HF with reduced ejection fraction [HFrEF]) were evaluated. LV volume was assessed by the method of disks and strain/strain rate were assessed by CMR feature tracking.
Integrating endocardial circumferential and longitudinal strain provided a close approximation of LV ejection fraction (EF), when compared to gold-standard volumetric assessment (EF: r = 0.94, P < 0.0001). Likewise, integrating circumferential and longitudinal strain rate provided a close approximation of peak ejection and peak filling rates (PER and PFR, respectively) compared to their gold-standard volume-time equivalents (PER, r = 0.73, P < 0.0001 and PFR, r = 0.78, P < 0.0001, respectively). Moreover, each integrated strain measure differentiated patients across the HF continuum (all P < 0.01), with the HFrEF group having worse EF, PER, and PFR compared to all other groups, and HFpEF having less favorable EF and PFR compared to both at-risk and control groups.
The data herein establish the theoretical framework for integrating discrete strain components into volumetric measurements across the cardiac cycle, and highlight the potential benefit of this approach for differentiating patients along the heart failure continuum.

© 2023. Society for Cardiovascular Magnetic Resonance.

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ABOUT THE EXPERTS

T Jake Samuel,Andrew P Oneglia,Daisha J Cipher,Justin A Ezekowitz,Jason R B Dyck,Todd Anderson,Jonathan G Howlett,D Ian Paterson,Richard B Thompson,Michael D Nelson

T Jake Samuel

College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA.

Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Andrew P Oneglia

College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA.

Daisha J Cipher

College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA.

Justin A Ezekowitz

Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.

Department of Medicine, University of Alberta, Edmonton, AB, Canada.

Jason R B Dyck

Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.

Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.

Todd Anderson

Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada.

Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.

Jonathan G Howlett

Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada.

D Ian Paterson

University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada.

Richard B Thompson

Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.

Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada.

Michael D Nelson

College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA. Michael.nelson3@uta.edu.

Applied Physiology and Advanced Imaging Laboratory, Department of Kinesiology, University of Texas at Arlington, 676 W. Nedderman Dr., Arlington, TX, 76019, USA. Michael.nelson3@uta.edu.