Cardiovascular MRI Feature-Tracking Strain Rate for Assessment of Diastolic Function

Purpose To compare left ventricular (LV) peak early diastolic strain rate (PEDSR) and peak late diastolic strain rate (PLDSR) using cardiac MRI feature tracking (FT) across a spectrum of diastolic dysfunction and determine the association between diastolic strain rates and cardiac remodeling. Materials and Methods Between October 2008 and December 2022, cardiac MRI and echocardiography were performed in prospectively recruited cohorts with type 2 diabetes mellitus, heart failure with preserved ejection fraction, and severe aortic stenosis, as well as asymptomatic participants without diabetes. Diastolic dysfunction was classified using established echocardiography guidelines. Global circumferential and longitudinal PEDSR and PLDSR were measured at cardiac MRI. Linear regression was performed to identify independent associations between LV diastolic strain rates and remodeling. Results A total of 600 participants (mean age, 65.2 years ± 8.4 [SD]; 361 of 600 male participants [60%]) were included. Proportions of participants with normal diastolic function and those with grade 1, indeterminate, and grade 2 or 3 diastolic dysfunction were 92 of 600 (15%), 401 of 600 (67%), 85 of 600 (14%), and 22 of 600 (4%), respectively. Compared with participants who had normal function, PEDSR decreased in those with grade 1 dysfunction (circumferential PEDSR, 0.99 sec^-1 ± 0.22 vs 0.81 sec^-1 ± 0.24 [P < .001]; longitudinal PEDSR, 0.79 sec^-1 ± 0.19 vs 0.60 sec^-1 ± 0.19 [P < .001]) and remained low throughout worsening stages of diastolic dysfunction. In contrast, compared with participants who had normal diastolic function, PLDSR increased in those with grade 1 dysfunction (circumferential PLDSR, 0.70 sec^-1 ± 0.17 vs 0.82 sec^-1 ± 0.23 [P < .001]; longitudinal PLDSR, 0.73 sec^-1 ± 0.18 vs 0.80 sec^-1 ± 0.27 [P < .001]) and declined progressively with worsening diastolic dysfunction. After multivariable adjustment for risk factors, inverse associations persisted between PEDSR and PLDSR with cardiac remodeling. Conclusion A distinctive pattern of cardiac MRI FT early and late diastolic strain rates was observed across the range of diastolic dysfunction. Keywords: Diastolic Dysfunction, Peak Early Diastolic Strain Rate, Peak Late Diastolic Strain Rate, Feature Tracking Supplemental material is available for this article. © The Author(s) 2025. Published by the Radiological Society of North America under a CC BY 4.0 license.