Feature-tracking cardiovascular magnetic resonance as a novel technique for the assessment of mechanical dyssynchrony.
BACKGROUND
Myocardial tagging using cardiovascular magnetic resonance (CMR) is the gold-standard for the assessment of myocardial mechanics. Feature-tracking cardiovascular magnetic resonance (FT-CMR) has been validated against myocardial tagging. We explore the potential of FT-CMR in the assessment of mechanical dyssynchrony, with reference to patients with cardiomyopathy and healthy controls.


METHODS
Healthy controls (n=55, age: 42.9 ± 13 yrs, LVEF: 70 ± 5%, QRS: 88 ± 9 ms) and patients with cardiomyopathy (n=108, age: 64.7 ± 12 yrs, LVEF: 29 ± 6%, QRS: 147 ± 29 ms) underwent FT-CMR for the assessment of the circumferential (CURE) and radial (RURE) uniformity ratio estimate based on myocardial strain (both CURE and RURE: 0 to 1; 1=perfect synchrony)


RESULTS
CURE (0.79 ± 0.14 vs. 0.97 ± 0.02) and RURE (0.71 ± 0.14 vs. 0.91 ± 0.04) were lower in patients with cardiomyopathy than in healthy controls (both p<0.0001). CURE (area under the receiver-operator characteristic curve [AUC]: 0.96), RURE (AUC: 0.96) and an average of these (CURE:RUREAVG, AUC: 0.98) had an excellent ability to discriminate between patients with cardiomyopathy and controls (sensitivity 90%; specificity 98% at a cut-off of 0.89). The time taken for semi-automatically tracking myocardial borders was 5.9 ± 1.4 min.


CONCLUSIONS
Dyssynchrony measures derived from FT-CMR, such as CURE and RURE, provide almost absolute discrimination between patients with cardiomyopathy and healthy controls. The rapid acquisition of these measures, which does not require specialized CMR sequences, has potential for the assessment of mechanical dyssynchrony in clinical practice.
Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
Robin J
RJ
Taylor
Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
Fraz
F
Umar
Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
William E
WE
Moody
Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
Chitra
C
Meyyappan
Bakken Research Center, Medtronic Inc., Maastricht, Netherlands.
Berthold
B
Stegemann
Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
John N
JN
Townend
Department of Cardiology, Nationwide Children's Hospital, Columbus, OH, USA.
Kan N
KN
Hor
Department of Clinical Radiology and Imaging Diagnostics, 4th Military Hospital, Wrocław, Center for Diagnosis, Prevention and Telemedicine, John Paul II Hospital, Krakow, Poland.
Tomasz
T
Miszalski-Jamka
The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA.
Wojciech
W
Mazur
Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
Richard P
RP
Steeds
Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom. Electronic address: cardiologists@hotmail.com.
Francisco
F
Leyva
D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged
CURE; Cardiovascular magnetic resonance; Dyssynchrony; Feature-tracking; Heart failure; RURE