Comparative Performance of Speckle Tracking Echocardiography and CMR Feature Tracking for Right Ventricular Myocardial Fibrosis in advanced heart failure.
Aug 2026· Journal of the American Society of Echocardiography· 0 citations
Medicine
TL;DR
3D-RVFWLS and CMR-derived RVFWLS are strongly correlated with RVMF in patients with advanced heart failure, and 3D-STE may be a promising technique that correlates with RVMF, providing a similar accuracy as CMR-FT in assessing RVMF.
Abstract
Background
Right ventricular free wall longitudinal strain (RVFWLS) assessed by three-dimensional speckle-tracking echocardiography (3D-STE), two-dimensional (2D) STE and cardiac magnetic resonance feature tracking (CMR-FT) has been reported to correlate with the degree of right ventricular myocardial fibrosis (RVMF), but the value of 3D-STE in evaluating RVMF compared with CMR-FT has not been investigated in patients with advanced heart failure.
Aims
This study aimed to determine which RVFWLS obtained by 2D-STE, 3D-STE, and CMR-FT, is the most robust noninvasive imaging marker for evaluating RVMF in patients with advanced heart failure using histopathological RVMF as the gold standard.
Methods
151 patients (118 male; mean age, 40±18 years) with advanced heart failure who underwent CMR, 2D and 3D echocardiographic examinations before heart transplantation were recruited in this study. RVFWLS was obtained from 2D-STE, 3D-STE and CMR-FT. The degree of RVMF was evaluated using late gadolinium enhancement (LGE) of CMR and Masson's staining in right ventricular myocardial samples, and patients were divided into three groups according to tertiles of histopathological RVMF.
Results
Patients with severe RVMF had lower 3D-RVFWLS, 2D-RVFWLS and CMR-derived RVFWLS, and higher CMR-LGE compared with those with mild and moderate RVMF. RVMF was strongly correlated with CMR-derived RVFWLS (r = 0.73, p < 0.001), 3D-RVFWLS (r = 0.72, p < 0.001) and CMR-LGE (r = 0.71, p < 0.001), and moderately correlated with 2D-RVFWLS (r = 0.56, p < 0.001). The correlations of CMR-derived RVFWLS and 3D-RVFWLS with RVMF were not different from correlation of CMR-LGE with RVMF (p > 0.05). CMR-LGE, CMR-derived RVFWLS and 3D-RVFWLS had similar performance in identifying severe RVMF (AUC: 0.90 vs 0.87 vs 0.85, all p > 0.05). The model with CMR-derived RVFWLS (R2 = 0.515, p < 0.001) had a similar ability to assess RVMF as the model with 3D-RVFWLS (R2 = 0.499, p < 0.001), but better than the model with 2D-RVFWLS (R2 = 0.340, p < 0.001).
Conclusions
3D-RVFWLS and CMR-derived RVFWLS are strongly correlated with RVMF in patients with advanced heart failure. 3D-STE may be a promising technique that correlates with RVMF, providing a similar accuracy as CMR-FT in assessing RVMF.
BACKGROUND
Two-dimensional (2D) speckle-tracking echocardiography (STE) for fibrosis detection has been validated against cardiac magnetic resonance late gadolinium enhancement (CMR-LGE) in hypertrophic cardiomyopathy (HCM), whereas 3-dimensional speckle-tracking echocardiography (3D-STE) may overcome limitations of 2D imaging.
OBJECTIVES
The authors aimed to evaluate whether 3D-STE can quantify replacement fibrosis as a surrogate for CMR-LGE.
METHODS
Two-dimensional speckle-tracking echocardiography, 3D-STE, and the extent of late gadolinium enhancement (%LGE) were prospectively measured in patients with HCM within ≤72 hours.
RESULTS
Among 511 patients with HCM (age 49.0 ± 14.3 years; men 340/511, 66.5%), strain parameters were significantly lower in patients with HCM and LGE [LGE (+)] than those in patients without LGE [LGE (-)]. Three-dimensional global longitudinal strain (GLS-3D) correlated moderately with GLS-2D (r = 0.622; 95% CI: 0.565-0.672; P < 0.001) and most strongly with %LGE (r = -0.698; 95% CI: -0.741 to -0.649; P < 0.001). A quadratic model explained the relationship between GLS-3D and %LGE better than the linear model (R2 = 0.448 vs 0.381). GLS-3D was independently associated with extensive LGE (%LGE ≥15%) (OR = 0.629; 95% CI: 0.553-0.716; P < 0.001), and showed the highest AUC for detecting extensive LGE (AUC = 0.894; 95% CI: 0.854-0.934; P < 0.001). At a cutoff value of 15.25%, GLS-3D yielded 87.3% sensitivity (95% CI: 75.5%-94.7%) and 78.3% specificity (95% CI: 74.4-82.2%).
CONCLUSIONS
GLS-3D showed the strongest correlation with %LGE among strain parameters and may serve as a surrogate marker for CMR-LGE in HCM.
Rong Wang, Li Zhang, Yue Gao et al.· JACC: Asia· 0 citations
BACKGROUND
The detection of myocardial ischemia in coronary artery disease (CAD) patients who lack regional wall motion abnormality (RWMA) at rest remains a clinical challenge. Two-dimensional speckle-tracking echocardiography (2D-STE) provides a quantitative and sensitive means of evaluating myocardial function, whereas stress echocardiography (SE) is a well-validated modality for identifying myocardial ischemia. Using the Gensini score (GS), this study intended to assess the diagnostic utility of combining these two techniques in evaluating coronary lesion severity in the aforementioned patient population.
METHODS
A cohort of 128 patients undergoing coronary angiography (CAG) without resting regional wall motion abnormality (RWMA) was enrolled in the study. Regadenoson stress echocardiography was performed in all patients. Apart from conventional echocardiographic parameters, two-dimensional strain parameters were measured at both resting and peak stress states. According to the GS, patients were categorized into two groups: a nonsignificant stenosis group (GS ≤ 38) and a significant stenosis group (GS > 38).
RESULTS
No statistically significant differences were identified between the two groups in any conventional echocardiographic parameters or strain parameters measured at rest (p > 0.05). Significant intergroup differences in global longitudinal strain (GLS), GLS change from rest to stress (ΔGLS), global circumferential strain (GCS) change from rest to stress (ΔGCS), and wall motion score index (WMSI) were detected between the significant stenosis group and the nonsignificant stenosis group during regadenoson stress (all p < 0.05). In contrast, GCS, global radial strain (GRS), and GRS change from rest to stress(ΔGRS) failed to show significant between-group disparities (p > 0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that ΔGLS exhibited the optimal diagnostic performance for identifying severe CAD (AUC = 0.928). Furthermore, a logical combination of ΔGLS and stress WMSI was employed to derive two diagnostic indicators with distinct clinical applicability.
CONCLUSION
Parameters obtained from 2D-STE combined with regadenoson SE demonstrate favorable diagnostic value for identifying severe CAD in patients without RWMA at rest. This approach may be particularly useful for special populations who are unable to undergo exercise stress testing or have chronic respiratory diseases and warrants further validation as a potential screening tool for significant coronary artery lesions in this patient cohort. Furthermore, the logical diagnostic combination based on ΔGLS and stress WMSI shows preliminary promise, although larger studies are needed to confirm its clinical applicability across diverse scenarios.
Wenqing Hui, Wenping Wang, Yutong Liu et al.· Journal of Clinical Ultrasou...· 0 citations
FT-CCT applied to clinically indicated CCTA provides a heart rate-robust, reproducible alternative to CMR for LV strain assessment in pediatric myocarditis and its high specificity and diagnostic equivalence support its role as a complementary tool for initial myocardial injury detection and risk stratification when CMR is not immediately available.
A multi-strain approach—SCS and SRS for transmural scar identification, SLS for early subendocardial injury—offers clinically meaningful, contrast-independent viability information that complements LGE imaging and supports risk stratification in this population.
Yomna Abdulwahab Mohmamed Rihan, M. Bilal, A. Sultan et al.· The Egyptian Journal of Radi...· 0 citations
In patients with ACM, FT-CMR reveals a characteristic peak strain gradient with relative preservation of apical segments in the longitudinal direction, TTP prolongation in the apical segments in all directions, and directionally variable PSSR values.
S. R. Sheriev, V. Fokin, A. V. Ryzhkov et al.· Russian Journal of Cardiolog...· 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
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