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01-09-2019 | Magnetic Resonance Imaging | Cardiac

Clinical usefulness of right ventricular 3D area strain in the assessment of treatment effects of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: comparison with 2D feature-tracking MRI

Authors: Masateru Kawakubo, Yuzo Yamasaki, Takeshi Kamitani, Koji Sagiyama, Yuko Matsuura, Takuya Hino, Kohtaro Abe, Kazuya Hosokawa, Hidetake Yabuuchi, Hiroshi Honda

Published in: European Radiology | Issue 9/2019

Abstract

Objectives

To evaluate the usefulness of right ventricular (RV) area strain analysis via cardiac MRI (CMRI) as a tool for assessing the treatment effects of balloon pulmonary angioplasty (BPA) in inoperable chronic thromboembolic pulmonary hypertension (CTEPH), RV area strain was compared to two-dimensional (2D) strain with feature-tracking MRI (FTMRI) before and after BPA.

Methods

We retrospectively analyzed 21 CTEPH patients who underwent BPA. End-systolic global area strain (GAS), longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) were measured before and after BPA. Changes in GAS and RV ejection fraction (RVEF) values after BPA were defined as ΔGAS and ΔRVEF. Receiver operating characteristic (ROC) analyses were performed to determine the optimal cutoff of the strain at after BPA for detection of improved patients with decreased mean pulmonary artery pressure (mPAP) less than 30 mmHg and increased RVEF more than 50%.

Results

ROC analysis revealed the optimal cutoffs of strains (GAS, LS, CS, and RS) for identifying improved patients with mPAP < 30 mmHg (cutoff (%) = − 41.2, − 13.8, − 16.7, and 14.4: area under the curve, 0.75, 0.56, 0.65, and 0.75) and patients with RVEF > 50% (cutoff (%) = − 37.2, − 29.5, − 2.9, and 14.4: area under the curve, 0.81, 0.60, 0.56, and 0.56).

Conclusions

Area strain analysis via CMRI may be a more useful tool for assessing the treatment effects of BPA in patients with CTEPH than 2D strains with FTMRI.

Key Points

• Area strain values can detect improvement of right ventricular (RV) pressure and function after balloon pulmonary angioplasty (BPA) equally or more accurately than two-dimensional strains.

• Area strain analysis is a useful analytical method that reflects improvements in complex RV myocardial deformation by BPA.

• Area strain analysis is a robust method with reproducibility equivalent to that of 2D strain analysis.

Pepke-Zaba J, Delcroix M, Lang I et al (2011) Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.110.015008

Moneta GL (2006) Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. Yearb Vasc Surg. https://doi.org/10.1016/S0749-4041(08)70317-8

Feinstein JA, Goldhaber SZ, Lock JE, Ferndandes SM, Landzberg MJ (2001) Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension. Circulation. https://doi.org/10.1161/01.CIR.103.1.10

Fukui S, Ogo T, Morita Y et al (2014) Right ventricular reverse remodelling after balloon pulmonary angioplasty. Eur Respir J. https://doi.org/10.1183/09031936.00012914

Kamimura Y, Okumura N, Adachi S et al (2018) Usefulness of scoring right ventricular function for assessment of prognostic factors in patients with chronic thromboembolic pulmonary hypertension. Heart Vessels. https://doi.org/10.1007/s00380-018-1168-7

Rolf A, Rixe J, Kim WK et al (2014) Right ventricular adaptation to pulmonary pressure load in patients with chronic thromboembolic pulmonary hypertension before and after successful pulmonary endarterectomy—a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. https://doi.org/10.1186/s12968-014-0096-7

Yamasaki Y, Nagao M, Abe K et al (2017) Balloon pulmonary angioplasty improves interventricular dyssynchrony in patients with inoperable chronic thromboembolic pulmonary hypertension: a cardiac MR imaging study. Int J Cardiovasc Imaging. https://doi.org/10.1007/s10554-016-0985-y

Surie S, Reesink HJ, Marcus JT et al (2013) Bosentan treatment is associated with improvement of right ventricular function and remodeling in chronic thromboembolic pulmonary hypertension. Clin Cardiol. https://doi.org/10.1002/clc.22197

Gorcsan J 3rd, Tanaka H (2011) Echocardiographic assessment of myocardial strain. J Am Coll Cardiol. https://doi.org/10.1016/j.jacc.2011.06.038

10.

Prati G, Vitrella G, Allocca G et al (2015) Right ventricular strain and dyssynchrony assessment in arrhythmogenic right ventricular cardiomyopathy: cardiac magnetic resonance feature-tracking study. Circ Cardiovasc Imaging. https://doi.org/10.1161/CIRCIMAGING.115.003647

11.

Pedrizzetti G, Claus P, Kilner PJ, Nagel E (2016) Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use. J Cardiovasc Magn Reson. https://doi.org/10.1186/s12968-016-0269-7

12.

Nagao M, Yamasaki Y (2018) Cardiac strain analysis using cine magnetic resonance imaging and computed tomography. Cardiovasc Imaging Asia. https://doi.org/10.22468/cvia.2018.00052

13.

Schuster A, Hor KN, Kowallick JT, Beerbaum P, Kutty S (2016) Cardiovascular magnetic resonance myocardial feature tracking: concepts and clinical applications. Circ Cardiovasc Imaging. https://doi.org/10.1161/CIRCIMAGING.115.004077

14.

Hor KN, Baumann R, Pedrizzetti G et al (2011) Magnetic resonance derived myocardial strain assessment using feature tracking. J Vis Exp. https://doi.org/10.3791/2356

15.

Wu VC, Takeuchi M, Otani K et al (2013) Effect of through-plane and twisting motion on left ventricular strain calculation: direct comparison between two-dimensional and three-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr. https://doi.org/10.1016/j.echo.2013.07.006

16.

Kowalik E, Kowalski M, Klisiewicz A, Hoffman P (2016) Global area strain is a sensitive marker of subendocardial damage in adults after optimal repair of aortic coarctation: three-dimensional speckle-tracking echocardiography data. Heart Vessels. https://doi.org/10.1007/s00380-016-0803-4

17.

Kleijn SA, Aly MFA, Terwee CB, Van Rossum AC, Kamp O (2011) Three-dimensional speckle tracking echocardiography for automatic assessment of global and regional left ventricular function based on area strain. J Am Soc Echocardiogr. https://doi.org/10.1016/j.echo.2011.01.014

18.

Ogawa A, Matsubara H (2015) Balloon pulmonary angioplasty: a treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension. Front Cardiovasc Med. https://doi.org/10.3389/fcvm.2015.00004

19.

Lang IM, Madani M (2014) Update on chronic thromboembolic pulmonary hypertension. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.114.009309

20.

Alfakih K, Plein S, Bloomer T, Jones T, Ridgway J, Sivananthan M (2003) Comparison of right ventricular volume measurements between axial and short axis orientation using steady-state free precession magnetic resonance imaging. J Magn Reson Imaging. https://doi.org/10.1002/jmri.10329

21.

Kawakubo M, Nagao M, Kumazawa S et al (2016) Evaluation of ventricular dysfunction using semi-automatic longitudinal strain analysis of four-chamber cine MR imaging. Int J Cardiovasc Imaging. https://doi.org/10.1007/s10554-015-0771-2

22.

Jamieson SW, Auger WR, Fedullo PF et al (1993) Experience and results with 150 pulmonary thromboendarterectomy operations over a 29-month period. J Thorac Cardiovasc Surg 106:116–126 discussion 126–127

23.

Hayashi K, Tsuda T, Nomura A et al (2018) Impact of B-type natriuretic peptide level on risk stratification of thromboembolism and death in patients with nonvalvular atrial fibrillation―the Hokuriku-Plus AF Registry. Circ J. https://doi.org/10.1253/circj.CJ-17-1085

24.

Maceira AM, Prasad SK, Khan M, Pennell DJ (2006) Reference right ventricular systolic and diastolic function normalized to age, gender and body surface area from steady-state free precession cardiovascular magnetic resonance. Eur Heart J. https://doi.org/10.1093/eurheartj/ehl336

25.

Hosokawa K, Abe K, Oi K, Mukai Y, Hirooka Y, Sunagawa K (2015) Negative acute hemodynamic response to balloon pulmonary angioplasty does not predicate the long-term outcome in patients with chronic thromboembolic pulmonary hypertension. Int J Cardiol. https://doi.org/10.1016/j.ijcard.2015.04.025

26.

Mizoguchi H, Ogawa A, Munemasa M, Mikouchi H, Ito H, Matsubara H (2012) Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv. https://doi.org/10.1161/CIRCINTERVENTIONS.112.971077

27.

Carluccio E, Biagioli P, Alunni G et al (2018) Prognostic value of right ventricular dysfunction in heart failure with reduced ejection fraction clinical perspective. Circ Cardiovasc Imaging. https://doi.org/10.1161/CIRCIMAGING.117.006894

28.

Lu KJ, Chen JXC, Profitis K et al (2015) Right ventricular global longitudinal strain is an independent predictor of right ventricular function: a multimodality study of cardiac magnetic resonance imaging, real time three-dimensional echocardiography and speckle tracking echocardiography. Echocardiography. https://doi.org/10.1111/echo.12783

29.

Leather HA, Ama' R, Missant C, Rex S, Rademakers FE, Wouters PF (2006) Longitudinal but not circumferential deformation reflects global contractile function in the right ventricle with open pericardium. Am J Physiol Heart Circ Physiol. https://doi.org/10.1152/ajpheart.01211.2004

30.

Jiang D, Niwa M, Koong AC, Diego S (2016) HHS public access. Eur J Vasc Endovasc Surg. https://www.ncbi.nlm.nih.gov/pubmed/?term=Right+Ventricular+Strain%2C+Torsion%2C+and+Dyssynchrony+in+Healthy+Subjects+using+3D+Spiral+Cine+DENSE+Magnetic+Resonance+Imaging

31.

López-Candales A, Edelman K, Candales MD (2010) Right ventricular apical contractility in acute pulmonary embolism: the McConnell sign revisited. Echocardiography. https://doi.org/10.1111/j.1540-8175.2009.01103.x

32.

Alfakih K, Plein S, Thiele H, Jones T, Ridgway JP, Sivananthan MU (2003) Normal human left and right ventricular dimensions for MRI as assessed by turbo gradient echo and steady-state free precession imaging sequences. J Magn Reson Imaging. https://doi.org/10.1002/jmri.10262

33.

Schmidt B, Dick A, Treutlein M et al (2017) Intra- and inter-observer reproducibility of global and regional magnetic resonance feature tracking derived strain parameters of the left and right ventricle. Eur J Radiol. https://doi.org/10.1016/j.ejrad.2017.01.025

34.

van Kessel M, Seaton D, Chan J et al (2017) Erratum to: Prognostic value of right ventricular free wall strain in pulmonary hypertension patients with pseudo-normalized tricuspid annular plane systolic excursion values. Int J Cardiovasc Imaging. https://doi.org/10.1007/s10554-016-1025-7

35.

Liu B, Dardeer AM, Moody WE, Edwards NC, Hudsmith LE, Steeds RP (2018) Normal values for myocardial deformation within the right heart measured by feature-tracking cardiovascular magnetic resonance imaging. Int J Cardiol. https://doi.org/10.1016/j.ijcard.2017.10.106

Title: Clinical usefulness of right ventricular 3D area strain in the assessment of treatment effects of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: comparison with 2D feature-tracking MRI
Authors: Masateru Kawakubo
Yuzo Yamasaki
Takeshi Kamitani
Koji Sagiyama
Yuko Matsuura
Takuya Hino
Kohtaro Abe
Kazuya Hosokawa
Hidetake Yabuuchi
Hiroshi Honda
Publication date: 01-09-2019
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Pulmonary Hypertension
Cardiac MRI
Pulmonary Hypertension
Pulmonary Hypertension
Pulmonary Hypertension
Published in: European Radiology / Issue 9/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-6008-3

At a glance: The STEP trials

Springer Medicine

Clinical usefulness of right ventricular 3D area strain in the assessment of treatment effects of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: comparison with 2D feature-tracking MRI

Abstract

Objectives

Methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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