Inter-vendor reproducibility of left and right ventricular cardiovascular magnetic resonance myocardial feature-tracking

<div><p>Aim</p><p>Since cardiovascular magnetic resonance feature-tracking (CMR-FT) has been demonstrated to be of incremental clinical merit we investigated the interchangeability of global left and right ventricular strain parameters between different CMR-FT software solutions.</p><p>Material and methods</p><p>CMR-cine images of 10 patients without significant reduction in LVEF and RVEF and 10 patients with a significantly impaired systolic function were analyzed using two different types of FT-software (TomTec, Germany; QStrain, Netherlands). Global longitudinal strains (LV GLS, RV GLS), global left ventricular circumferential (GCS) and radial strains (GRS) were assessed. Differences in intra- and inter-observer variability within and between software types based on single and up to three repeated and subsequently averaged measurements were evaluated.</p><p>Results</p><p>Inter-vendor agreement was highest for GCS followed by LV GLS. GRS and RV GLS showed lower inter-vendor agreement. Variability was consistently higher in healthy volunteers as compared to the patient group. Intra-vendor reproducibility was excellent for GCS, LV GLS and RV GLS, but lower for GRS. The impact of repeated measurements was most pronounced for GRS and RV GLS on an intra-vendor level.</p><p>Conclusion</p><p>Cardiac pathology has no influence on CMR-FT reproducibility. LV GLS and GCS qualify as the most robust parameters within and between individual software types. Since both parameters can be interchangeably assessed with different software solutions they may enter the clinical arena for optimized diagnostic and prognostic evaluation of cardiovascular morbidity and mortality in various pathologies.</p></div

Inter-vendor agreement and intra-vendor reproducibility at intra- and inter-observer levels for global longitudinal, global circumferential and global radial strain based on one measurement (R1).

<p>Inter-vendor agreement and intra-vendor reproducibility at intra- and inter-observer levels for global longitudinal, global circumferential and global radial strain based on one measurement (R1).</p

Example of LV circumferential strain assessments at the basal level and corresponding strain curves.

<p>Example of LV circumferential strain assessments at the basal level with TomTec (<i>Panel a</i>) and QStrain (<i>Panel b</i>). Manually contoured epicardial and endocardial borders and respective strain curves (<i>Panel c</i>) are being displayed for both types of software.</p

Patient demographics.

<p>Patient demographics.</p

Inter-vendor agreement on an intra- and inter-observer level for global longitudinal, global circumferential andglobal radial strain for the complete study cohort, normal subjects and patients with impaired cardiac function* based on three averaged measurements (R3).

<p>Inter-vendor agreement on an intra- and inter-observer level for global longitudinal, global circumferential andglobal radial strain for the complete study cohort, normal subjects and patients with impaired cardiac function* based on three averaged measurements (R3).</p

Inter-vendor agreement and intra-vendor reproducibility at intra- and inter-observer levels for global longitudinal, global circumferential and global radial strain based on two averaged measurements (R2).

<p>Inter-vendor agreement and intra-vendor reproducibility at intra- and inter-observer levels for global longitudinal, global circumferential and global radial strain based on two averaged measurements (R2).</p

Reproducibility for CMR-FT derived global strain parameters at intra- and inter-observer levels.

<p>Inter-vendor agreement for global strain parameters for healthy volunteers and patients with impaired cardiac output based on three averaged measurements (R3). <i>Panel a–d</i>: Bland-Altman plots with limits of agreement (95% confidence intervals) demonstrating the CMR-FT derived reproducibility at an intra-observer level are being displayed. <i>Panel e–h</i>: Bland-Altman plots with limits of agreement (95% confidence intervals) demonstrating the CMR-FT derived reproducibility at an inter-observer level are being displayed.</p