Assessment of global and regional strain left ventricular in patients with preserved ejection fraction after Fontan operation using a tissue tracking technique
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To evaluate the use of the tissue tracking (TT) technique to measure myocardial strain left ventricular in post-Fontan children with preserved ejection fraction (pEF). Nineteen (male/female, 10/9) patients with univentricular hearts after completion of the Fontan circulation (post-Fontan group) and 19 age- and gender-matched healthy children (control group) were retrospectively enrolled. Cardiovascular magnetic resonance (CMR) imaging was conducted on a 1.5-T MRI scanner. Global and regional strains of the left ventricle in post-Fontan patients (EF > 55%) and controls were obtained using CMR-TT software. The Mann–Whitney U test was used to compare parameters between the two groups. Correlation between EF and strain was investigated using Pearson correlation coefficients. The Bland–Altman method was used to identify the inter- and intra-observer agreement in measurement of global strain. Global longitudinal strain was lower in post-Fontan patients than in healthy controls (− 18.87 ± 4.61 vs. −19.72 ± 1.58; P = 0.54), though the difference was not statistically significant. Global circumferential strain and global radial strain were significantly lower in post-Fontan patients than in healthy controls (− 14.55 ± 3.79 vs. −19.91 ± 1.97; P < 0.001; and 29.62 ± 8.41 vs. 36.85 ± 5.95; P = 0.01; respectively). The regional circumferential strain (RCS) decrease was marked in regional segments compare with post-Fontan patients and controls (basal, − 11.81 ± 2.98 vs. − 16.21 ± 2.72, P < 0.001; mid, − 15.05 ± 3.31 vs. − 20.17 ± 2.28, P = 0.005; apical, − 16.86 ± 3.09 vs. − 23.37 ± 2.62, P < 0.001). All circumferential and longitudinal parameters had an inter-observer ICC of ≥ 0.85, but this coefficient was lower for radial parameters. CMR-TT appears to be a feasible technique for identification of early myocardial dysfunction in post-Fontan with pEF.
KeywordsFontan Cardiac magnetic resonance Strain Pediatric
Cardiovascular magnetic resonance
Global circumferential strain
Global longitudinal strain
Global radial strain
Left ventricular ejection fraction
Preserved ejection fraction
Regional circumferential strain
Regional radial strain
Steady-state free procession
The authors appreciate Hai-Tao You and Tong–Tong Han at the Circle Imaging Systems, Circle CVI Corporation Canada for their technical assistance.
LH—Study concepts and design; LH, AS—Clinical studies; YZ, LH, RO, CG, AS—Experimental studies/data analysis; YZ, LH, QW, AS—Statistical analysis; LH, AS, RO—Manuscript preparation; LH—Manuscript editing.
This work was supported by the Shanghai Municipal Commission of Health and Family Planning (Grant No. 20164Y0150); the Medical Engineering Cross Research Foundation of Shanghai Jiao Tong University (Grant No. YG2015QN25); and the Shanghai Hospital Development Center New Technology and Joint Research Projects (Grant No. SHDC12015128).
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to declare.
The study was approved by ethics committees of the University of Shanghai Jiao Tong University (SCMCIRB-K2017062). This study was approved by the ethics committee of our hospital, and all procedures were in accordance with the Declaration of Helsinki.
The parents gave informed consent to the participation of their children.
- 4.Hundley WG, Bluemke DA, Finn JP et al (2010) ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 121(22):2462–2508. https://doi.org/10.1016/j.jacc.2009.11.011 CrossRefGoogle Scholar
- 6.Augustine D, Lewandowski AJ, Lazdam M et al (2013) Global and regional left ventricular myocardial deformation measures by magnetic resonance feature tracking in healthy volunteers: comparison with tagging and relevance of gender. J Cardiovasc Magn Reson 15(1):8. https://doi.org/10.1186/1532-429X-15-8 CrossRefGoogle Scholar
- 7.Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 105(4):539–542. https://doi.org/10.1161/hc0402.102975 CrossRefGoogle Scholar
- 11.Shah AM, Claggett B, Sweitzer NK, Shah SJ, Deswal A, Anand IS et al (2015) Prognostic importance of changes in cardiac structure and function in heart failure with preserved ejection fraction and the impact of spironolactone. Circ Heart Fail 8(6):1052–1058. https://doi.org/10.1161/CIRCHEARTFAILURE.115.002249 CrossRefGoogle Scholar
- 16.Kutty S, Rangamani S, Venkataraman J et al (2013) Reduced global longitudinal and radial strain with normal left ventricular ejection fraction late after effective repair of aortic coarctation: a CMR feature tracking study. Int J Cardiovasc Imaging 29(1):141–150. https://doi.org/10.1007/s10554-012-0061-1 CrossRefGoogle Scholar
- 17.Berganza FM, de Alba CG, Özcelik N et al (2017) Cardiac magnetic resonance feature tracking biventricular two-dimensional and three-dimensional strains to evaluate ventricular function in children after repaired tetralogy of fallot as compared with healthy children. Pediatr Cardiol 38(3):566–574. https://doi.org/10.1007/s00246-016-1549-6 CrossRefGoogle Scholar
- 19.Moore CC, Lugo-Olivieri CH, McVeigh ER, Zerhouni EA (2000) Three-dimensional systolic strain patterns in the normal human left ventricle: characterization with tagged MR imaging. Radiology 214:453–466. https://doi.org/10.1148/radiology.214.2.r00fe17453 CrossRefGoogle Scholar
- 20.Truong UT, Li X, Broberg CS et al (2010) Significance of mechanical alterations in single ventricle patients on twisting and circumferential strain as determined by analysis of strain from gradient cine magnetic resonance imaging sequences. Am J Cardiol 105(10):1465–1469. https://doi.org/10.1016/j.amjcard.2009.12.074 CrossRefGoogle Scholar
- 24.Wen H, Liang Z, Zhao Y et al (2011) Feasibility of detecting early left ventricular systolic dysfunction using global area strain: a novel index derived from three-dimensional speckle-tracking echocardiography. Eur J Echocardiogr 12(12):910–916. https://doi.org/10.1093/ejechocard/jer162 CrossRefGoogle Scholar
- 29.André F, Robbersvisser D, Hellingbakki A et al (2017) Quantification of myocardial deformation in children by cardiovascular magnetic resonance feature tracking: determination of reference values for left ventricular strain and strain rate. J Cardiovasc Magn Reson 19(1):8. https://doi.org/10.1186/s12968-016-0310-x CrossRefGoogle Scholar