Left ventricular strain and hemodynamic forces from cine CMR for detecting constrictive physiology in pericarditis

Constrictive physiology (CP) may complicate pericarditis and requires timely recognition, yet CMR assessment is largely qualitative. This study evaluated the diagnostic value of cine-based strain and hemodynamic forces (HDF) analysis for distinguishing CP from non-constrictive physiology (NCP).

HDF analysis was retrospectively performed on routine 1.5 T cine images from 2008 to 2024 in patients with CMR-confirmed pericarditis. Patients were classified as CP or NCP non-invasively using guideline-defined clinical and imaging criteria. In addition to left ventricular (LV) function, global longitudinal strain (GLS), global circumferential strain (GCS), and HDF parameters (e.g., apical-basal [A-B] HDF strength) were analyzed. Student's t-test, binary logistic regression, and receiver operating characteristic analysis were performed.

Among 103 patients with pericarditis (mean age 53 ± 18 years), 42 (41%) had CP and 61 (59%) had NCP. LV ejection fraction did not differ between groups, whereas LV end-diastolic volume index was reduced in CP (62.0 ± 16.7 mL/m² vs 75.4 ± 18.2, p = 0.003). Strain and HDF parameters were significantly impaired in CP (e.g., A-B HDF strength: 15.3 ± 6.2% vs 21.4 ± 7.3%, p < 0.001). LV GLS and A-B HDF strength achieved good diagnostic performance for detecting CP (area under the curve [AUC] 0.76 and 0.78, respectively), further enhanced when combined (AUC 0.82). Both were independent predictors of CP on multivariable analysis (odds ratio [OR] 1.21, p = 0.002; and OR 0.83, p = 0.007, respectively).

LV strain and HDF analysis using routine CMR cine enabled quantitative detection of CP in pericarditis. A-B HDF strength, particularly in combination with LV GLS, provided the highest diagnostic accuracy.

Strain and HDF analysis derived from routine cine CMR enable detection of CP in pericarditis, providing novel quantitative parameters that complement conventional qualitative CMR assessment of CP without additional sequences.

CP may complicate pericarditis and can be addressed by targeted therapy, yet CMR diagnosis remains largely qualitative and challenging. Novel CMR metrics, including LV GLS and apical-basal HDF, showed good diagnostic performance. LV strain and HDF analysis from routine cine CMR cine enabled quantitative detection of CP in pericarditis without additional sequences.