Published in:
01-11-2020 | Computed Tomography | Cardiac
Characteristics of the left ventricular three-dimensional maximum principal strain using cardiac computed tomography: reference values from subjects with normal cardiac function
Published in: European Radiology | Issue 11/2020
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Objectives
This study evaluated the characteristics of left ventricular maximum principal strain (LV-MPS) using cardiac CT in subjects with normal LV function.
Methods
Of 973 subjects who underwent retrospective electrocardiogram-gated cardiac CT using a third-generation dual-source CT without beta-blocker administration, 31 subjects with preserved LV ejection fraction ≥ 55% assessed by echocardiography without coronary artery stenosis and cardiac pathology were retrospectively identified. CT images were reconstructed every 5% (0–95%) of the RR interval. LV-MPS and the time to peak (TTP) were analyzed using the 16-segment model and compared among three levels (base, mid, and apex) and among four regions (anterior, septum, inferior, and lateral) using the Steel–Dwass test. The intra- and inter-observer reproducibilities for LV-MPS were calculated using intraclass correlation coefficients (ICCs).
Results
The intra- and inter-observer ICCs (95% confidence interval) for peak LV-MPS were 0.96 (0.94–0.97) and 0.94 (0.92–0.96), respectively. The global peak LV-MPS (median, inter-quantile range) was 0.59 (0.55–0.72). The regional LV-MPS significantly increased in the order of the basal (0.54, 0.49–0.59), mid-LV (0.57, 0.53–0.65), and apex (0.68, 0.60–0.84) (p < 0.05, in each), and was significantly higher in the lateral wall (0.66, 0.60–0.77), while that in the septal region (0.47, 0.44–0.54) was the lowest among the four LV regions (all p < 0.05). No significant difference in TTP was seen among the myocardial levels and regions.
Conclusion
CT-derived LV-MPS is reproducible and quantitatively represents synchronized myocardial contraction with heterogeneous values in subjects with normal LV function.
Key Points
• CT-derived left ventricular maximum principal strain analysis allows highly reproducible quantitative assessments of left ventricular myocardial contraction.
• In subjects with normal cardiac function, the peak value of CT-derived left ventricular maximum principal strain is the highest in the apical level and in the lateral wall and the lowest in the septum.
• The regional peak left ventricular maximum principal strain shows intra-ventricular heterogeneity on a per-patient basis, but myocardial contraction is globally synchronized in subjects with normal cardiac function seen on cardiac CT.