Jeffrey Ji-Peng Li

Purpose: Echocardiographic studies have shown that patients with mitral valve prolapse (MVP) exhibit altered regional contraction patterns. With cardiovascular magnetic resonance (CMR) becoming increasingly important in the evaluation of global and regional cardiac function, we aimed to quantify the regional contraction patterns of patients with MVP using CMR feature tracking (FT) strain analysis in comparison to a control group. Methods: Of all patients who underwent CMR scans from 2013 to 2022 at our institution, 132 patients with MVP were identified and compared to 50 controls without any cardiac condition. CMR scans were performed on 1.5-T and 3-T scanners, and CMR-FT strain analysis was performed on cine images using MEDIS QStrain 4.1. The primary endpoints were regional peak left ventricular (LV) longitudinal strain values. Secondary endpoints included LV global circumferential strain (GCS) and global longitudinal strain (GLS) and left atrial (LA) reservoir strain and right ventricular (RV) free wall longitudinal strain. Differences between groups were assessed using linear regression models, adjusting for age and sex. Results: Patients with MVP showed worse regional peak longitudinal strain compared to controls in the basal and part of the medial LV segments, especially in segments S1, S4, S6, S7, and S12. In contrast, the apical segments S13, S14, S15, and S16 showed better strain values. Additionally, LA reservoir strain was reduced in MVP patients. LV GCS, LV GLS, and RV free wall longitudinal strain were similar between both groups. Conclusion: While patients with MVP showed preserved LV GCS and GLS compared to controls, LV regional longitudinal strain analysis showed impaired strain in the basal segments and increased strain in the apical segments.

Background: While left-bundle-branch-block-related contraction patterns as well as echocardiography-derived strain are variably associated with the volumetric response to cardiac resynchronization therapy (CRT), the role of CMR-derived strain parameters is unexplored. Methods: A total of 50 patients receiving CRT implantation were retrospectively analyzed, all of whom had undergone CMR imaging within one year before, and echocardiography within 6 months before and 6–12 months after CRT implantation. We assessed CMR-derived morphological and functional parameters with regard to the echocardiographic response, defined as a reduction in the left ventricular end-systolic volume of ≥15%. Results: Among the standard CMR parameters, the indexed right ventricular volumes in end-diastole (RVEDVi) (74.5 ± 19.5 vs. 94.8 ± 30.2 mL/m², p = 0.006) and end-systole (RVESVi) (43.2 ± 13.3 vs. 61.6 ± 28.8 mL/m², p = 0.003), as well as the left atrial (LA) area (24.8 ± 3.5 vs. 30.4 ± 9.5 cm², p = 0.020), differed significantly between CRT responders and non-responders. In strain analysis, CRT responders showed a significantly better LA global longitudinal strain (GLS) (25.1 ± 10.4 vs. 15.3 ± 10.5, p = 0.002), LA global circumferential strain (GCS) (27.9 ± 14.7 vs. 17.1 ± 13.1%, p = 0.012), RV GLS (−25.0 ± 6.5 vs. −18.9 ± 7.6%, p = 0.004) and RV free wall strain (−31.1 ± 7.9 vs. −24.9 ± 9.5, p = 0.017). Conclusions: CMR-derived peak septal circumferential strain and RVEDVi correlated with the echocardiographic volumetric response to CRT at 6–12 months.

Background: While left-bundle-branch-block-related contraction patterns as well as echocardiography derived strain are variably associated with volumetric response to cardiac resynchronization therapy (CRT), the role of CMR-derived strain parameters is unexplored. Methods: 50 patients receiving CRT implantation were retrospectively analysed, all of which had undergone CMR imaging within one year before, and echocardiography within 6 months before and 6-12 months after CRT implantation. We assessed CMR-derived morphological and functional parameters with regard to echocardiographic response, defined as reduction of left ventricular end-systolic volume ≥15%. Results: Among standard CMR parameters, indexed right ventricular volumes in end-diastole (RVEDVi) (74.5 ±19.5 vs. 94.8 ±30.2 ml/m², P=.006) and end-systole (RVESVi) (43.2 ±13.3 vs. 61.6 ±28.8 ml/m², P=.003) as well as left atrial (LA) area (24.8 ±3.5 vs. 30.4 ±9.5 cm², P=.020) differed significantly between CRT responders and non-responders. In strain analysis, CRT responders showed significantly better LA global longitudinal strain (GLS) (25.1 ±10.4 vs. 15.3 ±10.5, P=.002), LA global circumferential strain (GCS) (27.9 ±14.7 vs. 17.1 ±13.1%, P=.012), RV GLS (-25.0 ±6.5 vs. -18.9 ±7.6%, P=.004) and RV free wall strain (-31.1 ±7.9 vs. -24.9 ±9.5, P=.017). Conclusions: CMR-derived peak septal circumferential strain and RVEDVi correlated with echocardiographic volumetric response to CRT at 6-12 months.