Feature tracking compared with tissue tagging measurements of segmental strain by cardiovascular magnetic resonance

BACKGROUND: Left ventricular segmental wall motion analysis is important for clinical decision making in cardiac diseases. Strain analysis with myocardial tissue tagging is the non-invasive gold standard for quantitative assessment, however, it is time-consuming. Cardiovascular magnetic resonance myocardial feature-tracking (CMR-FT) can rapidly perform strain analysis, because it can be employed with standard CMR cine-imaging. The aim is to validate segmental peak systolic circumferential strain (peak SCS) and time to peak systolic circumferential strain (T2P-SCS) analysed by CMR-FT against tissue tagging, and determine its intra and inter-observer variability. METHODS: Patients in whom both cine CMR and tissue tagging has been performed were selected. CMR-FT analysis was done using endocardial (CMR-FT(endo)) and mid-wall contours (CMR-FT(mid)). The Intra Class Correlation Coefficient (ICC) and Pearson correlation were calculated. RESULTS: 10 healthy volunteers, 10 left bundle branch block (LBBB) and 10 hypertrophic cardiomyopathy patients were selected. With CMR-FT all 480 segments were analyzable and with tissue tagging 464 segments. Significant differences in mean peak SCS values of the total study group were present between CMR-FT(endo) and tissue tagging (-23.8 ± 9.9% vs -13.4 ± 3.3%, p < 0.001). Differences were smaller between CMR-FT(mid) and tissue tagging (-16.4 ± 6.1% vs -13.4 ± 3.3%, p = 0.001). The ICC of the mean peak SCS of the total study group between CMR-FT(endo) and tissue tagging was low (0.19 (95%-CI-0.10-0.49), p = 0.02). Comparable results were seen between CMR-FT(mid) and tissue tagging. In LBBB patients, mean T2P-SCS values measured with CMR-FT(endo) and CMR-FT(mid) were 418 ± 66 ms, 454 ± 60 ms, which were longer than with tissue tagging, 376 ± 55 ms, both p < 0.05. ICC of the mean T2P-SCS between CMR-FT(endo) and tissue tagging was 0.64 (95%-CI-0.36-0.81), p < 0.001, this was better in the healthy volunteers and LBBB group, whereas the ICC between CMR-FT(mid) and tissue tagging was lower. The intra and inter-observer agreement of segmental peak SCS with CMR-FT(mid) was lower compared with tissue tagging; similar results were seen for segmental T2P-SCS. CONCLUSIONS: The intra and inter-observer agreement of segmental peak SCS and T2P-SCS is substantially lower with CMR-FT(mid) compared with tissue tagging. Therefore, current segmental CMR-FT(mid) techniques are not yet applicable for clinical and research purposes.