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Updated: Aug 23, 2025
Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
Published on: February 12, 2011
Prognostic Utility of Cardiac MRI Myocardial Strain Parameters in Patients With Ischemic and Nonischemic Dilated
Hok Shing Tang1, Chi Ting Kwan1, Jianlong He2
1Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR.
Insights
Left ventricular global longitudinal strain (LV GLS) from cardiac MRI feature tracking predicts adverse outcomes in dilated cardiomyopathy (DCM) patients. This finding supports using LV GLS for improved patient management and risk stratification in DCM.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Conflicting results exist on the prognostic value of myocardial strain parameters from feature tracking (FT) on cardiac MRI in dilated cardiomyopathy (DCM).
- Previous studies were small and single-center, limiting generalizability.
Purpose of the Study:
- To assess the prognostic utility of FT parameters on cardiac MRI in patients with ischemic and nonischemic DCM.
- To identify the optimal strain parameter for predicting adverse outcomes in DCM patients.
Main Methods:
- Retrospective analysis of 471 DCM patients (ischemic n=233, nonischemic n=238) with LV ejection fraction <50% from four centers (2011-2019).
- Cardiac MRI with manual contouring and software-based FT to calculate six myocardial strain parameters (radial, circumferential, longitudinal) for LV and RV.
- Evaluation of late gadolinium enhancement (LGE) and composite outcome (all-cause mortality/heart failure hospitalization).
Main Results:
- All six FT strain parameters independently predicted the composite outcome (p < .05).
- In multivariable analysis, only LV global longitudinal strain (LV GLS) remained a significant independent predictor (HR=1.13, p=.006).
- LV ejection fraction and LGE were not independent predictors in multivariable models. A LV GLS threshold of -6.8% predicted the composite outcome at 4.0 years with 62.6% sensitivity and specificity.
Conclusions:
- LV GLS derived from FT on cardiac MRI is a significant independent predictor of adverse outcomes in DCM patients.
- This study supports the clinical implementation of FT for cardiac MRI in DCM patient assessment.
- LV GLS offers valuable prognostic information beyond traditional measures like LVEF and LGE.
Abstract:
BACKGROUND. Prior small single-center studies have yielded conflicting results regarding the prognostic significance of myocardial strain parameters derived from feature tracking (FT) on cardiac MRI in patients with dilated cardiomyopathy (DCM). OBJECTIVE. The purpose of this study was to evaluate the prognostic utility of FT parameters on cardiac MRI in patients with ischemic and nonischemic DCM and to determine the optimal strain parameter for outcome prediction. METHODS. This retrospective study included 471 patients (median age, 61 years; 365 men, 106 women) with ischemic (n = 233) or nonischemic (n = 238) DCM and left ventricular (LV) ejection fraction (EF) less than 50% who underwent cardiac MRI at any of four centers from January 2011 to December 2019. Cardiac MRI parameters were determined by manual contouring. In addition, software-based FT was used to calculate six myocardial strain parameters (LV and right ventricular [RV] global radial strain, global circumferential strain, and global longitudinal strain [GLS]). Late gadolinium enhancement (LGE) was also evaluated. Patients were assessed for a composite outcome of all-cause mortality and/or heart-failure hospitalization. Cox regression models were used to determine associations between strain parameters and the composite outcome. RESULTS. Mean LV EF was 27.5% and mean LV GLS was -6.9%. The median follow-up period was 1328 days. The composite outcome occurred in 220 patients (125 deaths, 95 heart-failure hospitalizations). All six myocardial strain parameters were significant independent predictors of the composite outcome (hazard ratio [HR] = 0.92-1.16; all p < .05). In multivariable models that included age, corrected LV and RV end-diastolic volume, LV and RV EF, and presence of LGE, the only strain parameter that was a significant independent predictor of the composite outcome was LV GLS (HR = 1.13, p = .006); LV EF and presence of LGE were not independent predictors of the composite outcome in the models (p > .05). A LV GLS threshold of -6.8% had sensitivity of 62.6% and specificity of 62.6% in predicting the composite outcome rate at 4.0 years. CONCLUSION. LV GLS, derived from FT on cardiac MRI, is a significant independent predictor of adverse outcomes in patients with DCM. CLINICAL IMPACT. This study strengthens the body of evidence supporting the clinical implementation of FT when performing cardiac MRI in patients with DCM.
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