Evaluation and Comparison of Quantitative Right Ventricular Strain Assessment by Cardiac Magnetic Resonance in Pulmonary Hypertension Using Feature Tracking and Deformable Registration Algorithms

Rationale and objective: Deformable registration algorithms (DRA) has been used to detect left ventricular myocardial changes, however, its clinical utility in right ventricular (RV) function has not been evaluated. In this study, we aim to evaluate and compare quantitative RV strain assessment by cardiac magnetic resonance in pulmonary hypertension (PH) using feature tracking (FT) and DRA. Materials and methods: Thirty patients were confirmed to have PH using right heart catheterization, and 16 healthy controls were evaluated with cardiac magnetic resonance. Global and segmental RV strain was measured by DRA and FT methods. Intraclass correlation coefficients (ICCs), coefficient of variation, and Bland-Altman analysis were used to assess and compare the interobserver and intraobserver variability of the DRA and FT methods. Results: DRA was more sensitive than FT in the detection of RV circumferential and septal dysfunction. The global longitudinal strain (GLS) obtained by the two methods was reduced in mild-moderate PH patients (mean pulmonary artery pressure<45 mm Hg), and the GLS and global circumferential strain (GCS) were reduced in severe PH patients (mean pulmonary artery pressure >45 mm Hg). DRA and FT methods demonstrate similar observer agreement in global strain using ICC (ICC greater than 0.90), but RV strain derived from DRA had lower variability using COV ([8%-14%] for DRA versus [11%-39%] for FT).For segmental longitudinal strain, DRA showed higher ICC and lower COV compared with that of the FT method. Correlations between RVEF and RV global strain parameters were strong (p < 0.01):GLS-DRA, r = -0.696; GLS-FT, r =-0.832; GCS-DRA, r =-0.745; and GCS-FT, r = -0.817. GLS-DRA was weakly correlated with mPAP (r = 0.385, p < 0.05).In multiple linear regression analysis, RVEF and mPAP were independent predictors of GLS-DRA (R-2 = 0.57, p < 0.01). Conclusions: The DRA method is more sensitive and robust for RV myocardial strain measurements than FT method.

Automated summary

The study aimed to assess RV strain in PH patients using DRA and FT methods, finding that DRA was more sensitive in detecting RV dysfunction and had lower variability in measuring global strain compared to FT method. Further analyses revealed strong correlations between RVEF, RV global strain parameters, and mPAP, with RVEF and mPAP independently predicting GLS-DRA.