Feature tracking CMR reveals abnormal strain in preclinical arrhythmogenic right ventricular dysplasia/ cardiomyopathy: a multisoftware feasibility and clinical implementation study.
Feature tracking CMR reveals abnormal strain in preclinical arrhythmogenic right ventricular dysplasia/ cardiomyopathy: a multisoftware feasibility and clinical implementation study.
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DOI：
10.1186/s12968-017-0380-4
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发表时间：
2017-09-01
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通讯作者：
Te Riele ASJM
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作者：
Bourfiss M;Vigneault DM;Aliyari Ghasebeh M;Murray B;James CA;Tichnell C;Mohamed Hoesein FA;Zimmerman SL;Kamel IR;Calkins H;Tandri H;Velthuis BK;Bluemke DA;Te Riele ASJM
局部右心室（RV）功能障碍是致心律失常性右心室发育不良/心肌病（ARVD/C）的标志，但目前仅在临床环境中进行定性评价。特征跟踪心血管磁共振（FT-CMR）是一种新的定量方法，使用电影CMR计算应变值。然而，大多数先前在ARVD/C中进行的FT-CMR研究都使用不同的软件方法关注全球RV毒株，使FT-CMR在临床实践中的实施复杂化。我们的目的是评估在ARVD/C中使用FT-CMR的全球和区域应变的临床价值，并确定市售FT-CMR软件包之间的差异。我们使用四种FT-CMR软件方法（多模态组织跟踪、TomTec、Medis和Circle Cardiovascular Imaging）分析了110例受试者（39例明显ARVD/C [突变+/表型+]、40例临床前ARVD/C [突变+/表型-]和31例对照）水平纵轴上的整体和局部（三尖瓣下、前、心尖）RV应变的电影CMR图像。使用Bland Altman图评估软件间一致性。对于整体应变，所有方法均显示与对照受试者相比，显性ARVD/C患者的应变降低（p < 0.041），而临床前与对照受试者无差异（p > 0.275）。对于局部应变，与对照受试者相比，ARVD/C患者的所有节段应变均降低，所有软件方法的三尖瓣下区域（p < 0.037）、两种方法的前壁（p < 0.005）和一种方法的心尖（p = 0.012）均达到统计学显著性。使用其中一种软件方法，与对照受试者相比，临床前受试者显示出异常的三尖瓣下应变（p = 0.009）。绝对应变值的软件方法之间的一致性较低（组内相关系数= 0.373）。尽管FT-CMR衍生应变值的软件间变异性较大，但所有四种软件方法均通过整体和三尖瓣下应变值将显性ARVD/C患者与对照受试者区分开来。在三尖瓣下区域，一个软件包区分了临床前和对照受试者，表明在明显疾病表达之前识别早期ARVD/C的潜力。本文的在线版本（10.1186/s12968-017-0380-4）包含补充材料，可供授权用户使用。
Regional right ventricular (RV) dysfunction is the hallmark of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C), but is currently only qualitatively evaluated in the clinical setting. Feature Tracking Cardiovascular Magnetic Resonance (FT-CMR) is a novel quantitative method that uses cine CMR to calculate strain values. However, most prior FT-CMR studies in ARVD/C have focused on global RV strain using different software methods, complicating implementation of FT-CMR in clinical practice. We aimed to assess the clinical value of global and regional strain using FT-CMR in ARVD/C and to determine differences between commercially available FT-CMR software packages. We analyzed cine CMR images of 110 subjects (39 overt ARVD/C [mutation+/phenotype+], 40 preclinical ARVD/C [mutation+/phenotype-] and 31 control) for global and regional (subtricuspid, anterior, apical) RV strain in the horizontal longitudinal axis using four FT-CMR software methods (Multimodality Tissue Tracking, TomTec, Medis and Circle Cardiovascular Imaging). Intersoftware agreement was assessed using Bland Altman plots. For global strain, all methods showed reduced strain in overt ARVD/C patients compared to control subjects (p < 0.041), whereas none distinguished preclinical from control subjects (p > 0.275). For regional strain, overt ARVD/C patients showed reduced strain compared to control subjects in all segments which reached statistical significance in the subtricuspid region for all software methods (p < 0.037), in the anterior wall for two methods (p < 0.005) and in the apex for one method (p = 0.012). Preclinical subjects showed abnormal subtricuspid strain compared to control subjects using one of the software methods (p = 0.009). Agreement between software methods for absolute strain values was low (Intraclass Correlation Coefficient = 0.373). Despite large intersoftware variability of FT-CMR derived strain values, all four software methods distinguished overt ARVD/C patients from control subjects by both global and subtricuspid strain values. In the subtricuspid region, one software package distinguished preclinical from control subjects, suggesting the potential to identify early ARVD/C prior to overt disease expression. The online version of this article (10.1186/s12968-017-0380-4) contains supplementary material, which is available to authorized users.