title: Comparison of left ventricular function assessment between echocardiography and MRI in Duchenne muscular dystrophy.
abstract: BACKGROUND
  Cardiomyopathy in Duchenne muscular dystrophy (DMD) is associated with death in approximately 40% of patients. Echocardiography is routinely used to assess left ventricular (LV) function; however, it has limitations in these patients.
  
  
  OBJECTIVE
  We compared echocardiographic measures of cardiac function assessment to cardiac MRI.
  
  
  METHODS
  We included children and young adults with DMD who had MRI performed between January 2010 and July 2015. We measured echocardiographic and MRI parameters of function assessment, including strain. Presence of late gadolinium enhancement (LGE) was assessed by MRI. Subjects were divided into two groups based on MRI left ventricular ejection fraction (LVEF): group I, LVEF ≥55% and group II, LVEF <55%.
  
  
  RESULTS
  We included 41 studies in 33 subjects, with 25 in group I and 16 in group II. Mean age of subjects was 13.6 ± 2.8 years and mean duration between echocardiogram and MRI was 7.6 ± 4.1 months. Only 8 of 16 (50%) patients in group II had diminished function on echocardiogram. Echocardiographic images were suboptimal in 16 subjects (39%). Overall, echocardiographic parameters had weak correlation with MRI-derived ejection fraction percentage. MRI-derived myocardial strain assessment has better correlation with MRI ejection fraction as compared to echocardiography-derived strain parameters.
  
  
  CONCLUSIONS
  Echocardiography-based ventricular functional assessment has weak correlation with MRI parameters in children and young adults with Duchenne muscular dystrophy. While this correlation improves in the subset of subjects with adequate echocardiographic image quality, it remains modest and potentially suboptimal for clinical management. Accordingly, we conclude that MRI should be performed routinely and early in children with DMD, not only for LGE imaging but also for functional assessment.
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA. sujatha.buddhe@seattlechildrens.org.
authors.forename: Sujatha
authors.initials: S
authors.lastname: Buddhe
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Lewin
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Olson
authors.affiliation: Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Ferguson
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Soriano
mesh_terms: D000293:Adolescent; D002648:Child; D004452:Echocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000000981:diagnostic imaging*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Children; Duchenne muscular dystrophy; Echocardiography; Magnetic resonance imaging; Strain analysis