RA phasic strain is impaired in ARVC even when RV function is preserved and in combination with RVGLS, RA conduit strain showed improved diagnostic performance and may serve as a potential adjunctive imaging marker, although further evaluation is required.
Abstract
Rationale
AND
Objectives
To evaluate the discriminative performance of right atrial (RA) phasic function in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients with preserved right ventricular (RV) function.
Materials And Methods
Right atrial and ventricular strain, together with conventional cardiac MRI (CMR) parameters, were assessed in 38 patients with ARVC and preserved RV function, 38 patients with ARVC and reduced RV function, and 38 healthy controls between January 2012 and May 2021.
Results
Compared to controls, ARVC patients with preserved RV function showed impaired RA reservoir and conduit strain, as well as reduced RA passive emptying fraction, despite normal RA size. RA conduit strain <17% showed discriminative performance for identifying ARVC with preserved RV function (AUC = 0.79). The combination of RA conduit strain and RV global longitudinal strain (RVGLS) further improved discriminative performance (AUC = 0.89, P < 0.001). Multivariable logistic regression identified RA conduit strain (OR = 0.88, P = 0.005) and RVGLS (OR = 1.37, P < 0.001) as independently associated factors. In addition, RA conduit strain impairment showed modest incremental diagnostic value beyond RVGLS (χ² increased from 31.6 to 41.3, P = 0.002) and correlated with more advanced RV dysfunction and higher N-terminal pro-brain natriuretic peptide (NT-proBNP) levels across the overall ARVC cohort.
Conclusion
RA phasic strain is impaired in ARVC even when RV function is preserved. In combination with RVGLS, RA conduit strain showed improved diagnostic performance and may serve as a potential adjunctive imaging marker, although further evaluation is required.
Right ventricular free-wall longitudinal strain is a robust determinant of adverse outcomes beyond conventional LV indices and A4C-LVLS in VFMR and might be incorporated into routine evaluation to improve risk stratification in VFMR.
Chung-Yen Lee, Chi-Han Wu, Hsuan-Hao Hsu et al.· Journal of the American Soci...· 0 citations
Background: Pulmonary hypertension (PH) is associated with increased pulmonary arterial pressure and impairment of right ventricular (RV) function. Reliable characterization of RV performance is important for prognosis, risk assessment, and therapeutic planning. Cardiac magnetic resonance (CMR) is considered the reference technique for quantifying RV volumes and function, but its expense and limited availability can restrict routine implementation. Echocardiography is more widely accessible; however, the extent to which individual echocardiographic indices correspond with CMR-derived RV ejection fraction (RVEF) remains incompletely defined. Objective: Our objective was to determine the correlation of RV fractional area change (RV-FAC), RV free-wall longitudinal strain (RV-FWLS), and RV global longitudinal strain (RV-GLS) with CMR-derived RVEF in individuals with PH. Methods: PubMed, Embase, ClinicalTrials.gov, Scopus, and the Cochrane Library were searched, yielding 404 records; six studies fulfilled the eligibility criteria. Studies were eligible when they enrolled patients with PH and provided extractable correlations between at least one prespecified echocardiographic measure and CMR-derived RVEF. Correlation coefficients were converted with Fisher’s z transformation, combined using common-effect and random-effects approaches, and then transformed back to correlation coefficients. Pooled mean RV-FAC was evaluated as a separate outcome. Between-study heterogeneity was quantified with I2 and τ2, with random-effects estimates emphasized for interpretation. Results: Each evaluated echocardiographic measure was positively correlated with CMR-derived RVEF. RV-FWLS had the largest pooled correlation and the greatest consistency (r = 0.79, 95% CI: 0.73–0.83; I2 = 0.0%). The pooled correlation for RV-GLS was 0.75 (95% CI: 0.60–0.85; I2 = 80.3%), while that for RV-FAC was 0.72 (95% CI: 0.61–0.80; I2 = 61.8%). The random-effects pooled mean RV-FAC was 31.10% (95% CI: 26.77–35.43), with substantial heterogeneity (I2 = 90.9%). Conclusions: RV-FWLS showed the highest numerical and most consistent association with CMR-derived RVEF, suggesting that it may serve as a useful non-invasive adjunct for RV assessment in PH, especially where CMR is not readily available. Larger studies using harmonized acquisition and analysis methods are required for confirmation.
Faizan Ahmed, A. Zulfiqar, Ramsha Ali et al.· Diagnostics· 0 citations
Background Differentiating cardiac amyloidosis (CA) from hypertrophic cardiomyopathy (HCM) is clinically challenging due to overlapping phenotypes of left ventricular hypertrophy. This study aimed to evaluate the diagnostic value of cardiac magnetic resonance (CMR)-derived left atrial strain parameters in differentiating CA from HCM. Methods A retrospective analysis was performed on CMR data obtained from 37 patients with HCM, 41 patients with CA, and 29 individuals in the normal control group. Left ventricular and left atrial functions were quantified using CVI42 software (version 5.14.2). Left atrial strain parameters were assessed using the tissue tracking module, including left atrial reservoir strain (εs) and strain rate (SRs), conduit strain (εe) and strain rate (SRe), and booster strain (εa) and strain rate (SRa). Differences in left ventricular and left atrial functional parameters, as well as left atrial strain parameters among the three groups, were analyzed using the Kruskal-Wallis test. Pairwise comparisons were conducted using the Mann-Whitney U test. Receiver operating characteristic (ROC) curve analysis was performed using MedCalc (version 15.2.2) to determine the diagnostic efficacy of left atrial strain parameters in differentiating CA from HCM. Results The absolute values of εs, εe, εa, SRs, SRe, and SRa were significantly lower in both the HCM and CA groups compared with the normal control group (P<0.05). Furthermore, the absolute values of these parameters were markedly lower in CA compared with HCM (P<0.05). Among these parameters, εs demonstrated the highest diagnostic performance for distinguishing CA from HCM, with an area under the ROC curve of 0.921. Conclusions CMR-derived left atrial strain parameters, particularly εs, might serve as a reliable means for differentiating between HCM and CA, which need further prospective study including patients with all HCM types and conducting internal and external validation to confirm credibility and expand generalizability.
Ya-Nan Jin, Xiao-Ning Shao, Yong Zhang et al.· Quantitative Imaging in Medi...· 0 citations
BACKGROUND
Right ventricular (RV) to left ventricular (LV) end-diastolic volume ratio (RV/LV) is a validated marker of RV dilation in pulmonary arterial hypertension (PAH), yet its impact on LV myocardial function and the underlying mediating pathway is incompletely characterized.
PURPOSE
To investigate the association between RV/LV volume ratio and LV dysfunction in PAH patients, with a focus on regional strain patterns and mediating pathways.
STUDY TYPE
Retrospective.
POPULATION
188 PAH patients were divided into normal (ratio < 1.27, n = 74) and elevated (ratio ≥ 1.27, n = 114) RV/LV volume ratio groups, and 81 age- and sex-matched controls.
FIELD STRENGTH/SEQUENCE
3.0-T/balanced steady-state free precession cine sequence.
ASSESSMENT
LV global longitudinal, circumferential, and radial strains (LVGLS, LVGCS, and LVGRS, respectively) and regional strains were measured using feature tracking. Strain parameters were compared among controls and PAH subgroups.
STATISTICAL TESTS
One-way ANOVA with Bonferroni-corrected post hoc tests, Kruskal-Wallis test, and Pearson or Spearman correlation. Multivariable linear regression was used to identify independent determinants and mediation analysis to examine the mediating pathways. A two-tailed p < 0.05 was deemed statistically significant.
RESULTS
PAH patients with elevated volume ratio had significantly reduced LVGCS and LVGLS. Regional analysis showed that the most extensive strain impairment was at the mid-ventricular septum. The RV/LV volume ratio was independently associated with LVGCS (β = -0.194) and LVGLS (β = -0.307). Mediation analysis demonstrated that the mPAP-LVGLS relationship was statistically mediated by the RV/LV volume ratio, with a significant indirect effect (β = -0.192, 95% confidence interval: -0.302 to -0.096) and a non-significant (p = 0.544) direct effect.
DATA CONCLUSION
Elevated RV/LV volume ratio in PAH is associated with spatially heterogeneous LV strain impairment, with the mid-septum being most vulnerable. The ratio mediates the adverse impact of pulmonary pressure on LV longitudinal strain and may serve as an imaging marker for assessing LV dysfunction.
EVIDENCE LEVEL
3.
TECHNICAL EFFICACY
Stage 3.
Han Fang, Yuan Li, Jin Wang et al.· Journal of Magnetic Resonanc...· 1 citation
Obesity is associated with cardiac remodeling and increased cardiovascular risk. While left ventricular changes have been extensively studied, the impact of obesity on the right heart remains less well characterized.
We aimed to assess right atrial (RA) and right ventricular (RV) morphology, function, and myocardial deformation across obesity classes and their association with anthropometric and metabolic parameters.
This cross-sectional study included 126 adults with overweight and obesity. Echocardiographic assessment comprised RA and RV dimensions, RV systolic function (TAPSE, FAC, and s'TDI), RV global longitudinal strain (RV GLS), and RA strain analysis, including reservoir (PALS) and contractile (PACS) function. Comparisons were performed according to obesity class, and correlations with adiposity and metabolic markers were analyzed.
Subjects with class III obesity demonstrated significantly larger indexed RA short-axis dimensions than those with class I and II obesity (p=0.001), suggesting early RA remodeling. RV dimensions, FAC, TAPSE, RV GLS, and RV free-wall GLS did not differ significantly among obesity classes and showed no meaningful associations with anthropometric or metabolic variables. In contrast, PALS showed negative correlations with body mass index (r=-0.220, p=0.014), waist circumference (r=-0.174, p=0.053), and hip circumference (r=-0.182, p=0.045). PACS was positively associated with fasting insulin (r=0.216, p=0.016) and HOMA-IR (r=0.214, p=0.017).
Impaired RA reservoir function appears to be an early manifestation of obesity-related cardiac involvement, whereas RV function and strain remain preserved. RA strain may serve as a sensitive marker of subclinical right heart dysfunction in obesity.
C. V. Ilijevska, S. Mishevska, M. Z. Hristova et al.· European Journal of Endocrin...· 0 citations
