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Updated: Jul 12, 2026
Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
Published on: February 12, 2011
Evaluating left atrial strain and left ventricular diastolic strain rate as markers for diastolic dysfunction in
Edward W Chen1, Zubair Bashir2, Jessica L Churchill2
1Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Insights
Left atrial strain and early diastolic strain rate do not accurately predict elevated left ventricular filling pressures in patients with mitral annular calcification. Further research is needed before routine clinical use.
Area of Science:
- Cardiology
- Echocardiography
- Diastolic Function Assessment
Background:
- Mitral annular calcification (MAC) complicates standard echocardiographic evaluation of diastolic function.
- Left atrial (LA) strain and early diastolic strain rate (DSr) are emerging noninvasive methods for assessing diastolic function.
- Speckle-tracking echocardiography (STE) is used to measure LA strain and DSr.
Purpose of the Study:
- To evaluate the utility of LA strain and early DSr in predicting elevated left ventricular filling pressures (LVFP) in patients with MAC.
- To compare the effectiveness of LA strain and early DSr with the mitral inflow velocity E/A ratio in predicting elevated LVFP.
Main Methods:
- Adult patients with MAC undergoing transthoracic echocardiogram (TTE) and cardiac catheterization for LVFP measurement were included.
- Spearman's rank correlation and receiver operating characteristic (ROC) curves were used to assess associations and discriminatory ability.
- LA reservoir strain, average early DSr, and E/A ratio were analyzed for their predictive capabilities.
Main Results:
- LA reservoir strain showed poor correlation (rho=0.03) and discriminatory ability (AUC=0.54) for elevated LVFP.
- Average early DSr also demonstrated poor correlation (rho=-0.19) and discriminatory ability (AUC=0.59) for elevated LVFP.
- Neither LA strain nor early DSr, alone or combined with the E/A ratio, significantly improved the prediction of elevated LVFP compared to the E/A ratio alone.
Conclusions:
- LA reservoir strain and early DSr were found to be inaccurate predictors of diastolic filling pressure in patients with MAC in this study.
- Additional research is necessary to determine the clinical applicability of LA strain and early DSr for assessing filling pressures in MAC patients.
Background:
Mitral annular calcification (MAC) poses many challenges to the evaluation of diastolic function using standard echocardiography. Left atrial (LA) strain and left ventricular early diastolic strain rate (DSr) measured by speckle-tracking echocardiography (STE) are emerging techniques in the noninvasive evaluation of diastolic function. We aim to evaluate the utility of LA strain and early DSr in predicting elevated left ventricular filling pressures (LVFP) in patients with MAC and compare their effectiveness to ratio of mitral inflow velocity in early and late diastole (E/A).
Methods:
We included adult patients with MAC who presented between January 1 and December 31, 2014 and received a transthoracic echocardiogram (TTE) and cardiac catheterization with measurement of LVFP within a 24-h period. We used Spearman's rank correlation coefficient to assess associations of LA reservoir strain and average early DSr with LVFP. Receiver operating characteristic (ROC) curves were computed to assess the effectiveness of LA strain and DSr in discriminating elevated LVFP as a dichotomized variable and to compare their effectiveness with E/A ratio categorized according to grade of diastolic dysfunction.
Results:
Fifty-five patients were included. LA reservoir strain demonstrated poor correlation with LVFP (Spearman's rho = 0.03, p = 0.81) and poor discriminatory ability for detecting elevated LVFP (AUC = 0.54, 95% CI 0.38-0.69). Categorical E/A ratio alone also demonstrated poor discriminatory ability (AUC = 0.53, 95% CI 0.39-0.67), and addition of LA reservoir strain did not significantly improve effectiveness (AUC = 0.58, 95% CI 0.42-0.74, p = 0.56). Average early DSr also demonstrated poor correlation with LVFP (Spearman's rho = -0.19, p = 0.16) and poor discriminatory ability for detecting elevated LVFP (AUC = 0.59, 95% CI 0.44-0.75). Addition of average early DSr to categorical E/A ratio failed to improve effectiveness (AUC = 0.62, 95% CI 0.46-0.77 vs. AUC = 0.54, 95% CI 0.39-0.69, p = 0.38).
Conclusions:
In our sample, LA reservoir strain and DSr do not accurately predict diastolic filling pressure. Further research is required before LA strain and early DSr can be routinely used in clinical practice to assess filling pressure in patients with MAC.
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