Integration of longitudinal and circumferential strain predicts volumetric change across the cardiac cycle and differentiates patients along the heart failure continuum

T Jake Samuel; Andrew P Oneglia; Daisha J Cipher; Justin A Ezekowitz; Jason R B Dyck; Todd Anderson; Jonathan G Howlett; D Ian Paterson; Richard B Thompson; Michael D Nelson

doi:10.1186/s12968-023-00969-2

Integration of longitudinal and circumferential strain predicts volumetric change across the cardiac cycle and differentiates patients along the heart failure continuum

J Cardiovasc Magn Reson. 2023 Oct 2;25(1):55. doi: 10.1186/s12968-023-00969-2.

Authors

T Jake Samuel^{1

2}, Andrew P Oneglia¹, Daisha J Cipher¹, Justin A Ezekowitz^{3

4}, Jason R B Dyck^{3

5}, Todd Anderson^{6

7}, Jonathan G Howlett⁶, D Ian Paterson⁸, Richard B Thompson^{3

9}, Michael D Nelson^{10

11}

Affiliations

¹ College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA.
² Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.
⁴ Department of Medicine, University of Alberta, Edmonton, AB, Canada.
⁵ Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
⁶ Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada.
⁷ Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.
⁸ University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada.
⁹ Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada.
¹⁰ College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA. Michael.nelson3@uta.edu.
¹¹ Applied Physiology and Advanced Imaging Laboratory, Department of Kinesiology, University of Texas at Arlington, 676 W. Nedderman Dr., Arlington, TX, 76019, USA. Michael.nelson3@uta.edu.

Abstract

Background: Left ventricular (LV) circumferential and longitudinal strain provide important insight into LV mechanics and function, each contributing to volumetric changes throughout the cardiac cycle. We sought to explore this strain-volume relationship in more detail, by mathematically integrating circumferential and longitudinal strain and strain rate to predict LV volume and volumetric rates of change.

Methods: Cardiac magnetic resonance (CMR) imaging from 229 participants from the Alberta HEART Study (46 healthy controls, 77 individuals at risk for developing heart failure [HF], 70 patients with diagnosed HF with preserved ejection fraction [HFpEF], and 36 patients with diagnosed HF with reduced ejection fraction [HFrEF]) were evaluated. LV volume was assessed by the method of disks and strain/strain rate were assessed by CMR feature tracking.

Results: Integrating endocardial circumferential and longitudinal strain provided a close approximation of LV ejection fraction (EF_Strain), when compared to gold-standard volumetric assessment (EF_Volume: r = 0.94, P < 0.0001). Likewise, integrating circumferential and longitudinal strain rate provided a close approximation of peak ejection and peak filling rates (PER_Strain and PFR_Strain, respectively) compared to their gold-standard volume-time equivalents (PER_Volume, r = 0.73, P < 0.0001 and PFR_Volume, r = 0.78, P < 0.0001, respectively). Moreover, each integrated strain measure differentiated patients across the HF continuum (all P < 0.01), with the HFrEF group having worse EF_Strain, PER_Strain, and PFR_Strain compared to all other groups, and HFpEF having less favorable EF_Strain and PFR_Strain compared to both at-risk and control groups.

Conclusions: The data herein establish the theoretical framework for integrating discrete strain components into volumetric measurements across the cardiac cycle, and highlight the potential benefit of this approach for differentiating patients along the heart failure continuum.

Keywords: Ejection fraction; Ejection rate; Filling rate; Strain; Volume-time.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Heart
Heart Failure*
Humans
Predictive Value of Tests
Stroke Volume
Ventricular Function, Left

Grants and funding

R01 HL136601/HL/NHLBI NIH HHS/United States