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Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
Published on: February 12, 2011
Myocardial Strain in the Assessment of Patients With Heart Failure: A Review
Thomas H Marwick1, Sanjiv J Shah2,3, James D Thomas2
1Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Insights
Strain imaging offers a validated, robust method for assessing heart failure (HF) beyond traditional ejection fraction. This technique provides crucial insights into myocardial mechanics for risk prediction, diagnosis, and treatment monitoring in HF patients.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Traditional heart failure (HF) imaging relies on systolic and diastolic function, and left ventricular (LV) filling pressure.
- Conventional markers like ejection fraction and E/e' have limitations, particularly for HF with preserved ejection fraction.
- Strain imaging, a novel echocardiographic technique, offers a window into myocardial mechanics.
Purpose of the Study:
- To review the evidence for myocardial strain imaging in various stages of heart failure.
- To highlight the utility of LV global longitudinal strain and other strain parameters.
- To demonstrate the role of strain imaging in risk prediction, diagnosis, treatment response assessment, and follow-up.
Main Methods:
- Review of existing evidence on myocardial strain imaging in heart failure.
- Focus on LV global longitudinal strain and other strain parameters.
- Application across 9 distinct situations in HF management.
Main Results:
- Myocardial strain imaging is well-validated and robust.
- It can be readily implemented on modern echocardiography machines.
- Strain parameters provide valuable information for HF assessment and risk stratification.
Conclusions:
- Myocardial deformation imaging, specifically strain imaging, is evolving from a research tool to clinical practice.
- It offers clinicians a valuable additional imaging parameter for HF assessment.
- Strain imaging facilitates improved risk evaluation and patient management in heart failure.
Importance:
The cornerstones of imaging in heart failure (HF) are the measurement of systolic and diastolic function and left ventricular (LV) filling pressure.
Observations:
Ejection fraction and the assessment of LV filling pressure and diastolic dysfunction using the ratio of early transmitral flow and LV relaxation (E/e') are conventional imaging markers of LV function. Despite their extensive use in HF guidelines, both have significant detractions, especially in an era when HF with preserved ejection fraction is becoming the dominant presentation. In contrast, strain imaging has provided a new window into myocardial mechanics. Myocardial strain is now well validated, robust, and can easily be performed on most modern echocardiography machines. This Review summarizes the evidence in 9 situations across the stages of HF where LV global longitudinal strain and other strain parameters may provide information on risk prediction, diagnosis, assessment of treatment response, and follow-up.
Conclusions And Relevance:
The evolution of myocardial deformation imaging from research tool to clinical practice will provide clinicians with a useful additional imaging parameter to facilitate the assessment and risk evaluation of patients with HF.
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