Right ventricular strain by MR quantitatively identifies regional dysfunction in patients with arrhythmogenic right ventricular cardiomyopathy.
BACKGROUND
Analysis of regional wall motion of the right ventricle (RV) is primarily qualitative with large interobserver variation in clinical practice. Thus, the purpose of this study was to use feature tracking to analyze regional wall motion abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).


METHODS
We enrolled 110 subjects (39 overt ARVC [mutation+/phenotype+] (35.5%), 40 preclinical ARVC [mutation+/phenotype-] (36.3%), and 31 control subjects (28.2%)). Cine steady state free precession cardiac MR was performed with temporal resolution ≤40 ms in the horizontal long axis (HLA), axial, and short axis directions. Regional strain was analyzed using feature tracking software and reproducibility was assessed by means of intraclass correlation coefficient. Dunnett's test was used in univariate analysis for comparisons to control subjects; cumulative odds logistic regression was used for minimally and fully adjusted multivariate models.


RESULTS
Strain was significantly impaired in overt ARVC compared with control subjects both globally (P < 0.01) and regionally (all segments of HLA view, P < 0.01). In the HLA view, regional reproducibility was excellent within (intraclass correlation coefficient [ICC] = 0.81) and moderate between (ICC = 0.62) observers. Using a threshold of -31% subtricuspid strain in the HLA view, the sensitivity and specificity for overt ARVC were 75.0% and 78.2%, respectively. In multivariable analysis involving all three groups, subtricuspid strain less than -31% (beta = 1.38; P = 0.014) and RV end diastolic volume index (beta = 0.06; P = 0.001) were significant predictors of disease presence.


CONCLUSIONS
RV strain can be reproducibly assessed with MR feature tracking, and regional strain is abnormal in overt ARVC compared with control subjects.
Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, Maryland, USA.|Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Headington, Oxford, United Kingdom.|Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA.
Davis M
DM
Vigneault
Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA.|Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Anneline S J M
AS
te Riele
Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Cynthia A
CA
James
Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Stefan L
SL
Zimmerman
Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, Maryland, USA.|Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.
Mariana
M
Selwaness
Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Brittney
B
Murray
Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Crystal
C
Tichnell
Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, Maryland, USA.|Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Headington, Oxford, United Kingdom.
Michael
M
Tee
Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Headington, Oxford, United Kingdom.
J Alison
JA
Noble
Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Hugh
H
Calkins
Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Harikrishna
H
Tandri
Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, Maryland, USA.
David A
DA
Bluemke
D000293:Adolescent; D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009038:Motion; D015999:Multivariate Analysis; D009154:Mutation; D016017:Odds Ratio; D010641:Phenotype; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012984:Software; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology; D016278:Ventricular Function, Right
cardiac magnetic resonance (MR); magnetic resonance imaging (MRI); strain, feature tracking, arrhythmogenic right ventricular cardiomyopathy (ARVC)