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Clinical usefulness of right ventricular 3D area strain in the assessment of treatment effects of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: comparison with 2D feature-tracking MRI

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Abstract

Objectives

To evaluate the usefulness of right ventricular (RV) area strain analysis via cardiac MRI (CMRI) as a tool for assessing the treatment effects of balloon pulmonary angioplasty (BPA) in inoperable chronic thromboembolic pulmonary hypertension (CTEPH), RV area strain was compared to two-dimensional (2D) strain with feature-tracking MRI (FTMRI) before and after BPA.

Methods

We retrospectively analyzed 21 CTEPH patients who underwent BPA. End-systolic global area strain (GAS), longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) were measured before and after BPA. Changes in GAS and RV ejection fraction (RVEF) values after BPA were defined as ΔGAS and ΔRVEF. Receiver operating characteristic (ROC) analyses were performed to determine the optimal cutoff of the strain at after BPA for detection of improved patients with decreased mean pulmonary artery pressure (mPAP) less than 30 mmHg and increased RVEF more than 50%.

Results

ROC analysis revealed the optimal cutoffs of strains (GAS, LS, CS, and RS) for identifying improved patients with mPAP < 30 mmHg (cutoff (%) = − 41.2, − 13.8, − 16.7, and 14.4: area under the curve, 0.75, 0.56, 0.65, and 0.75) and patients with RVEF > 50% (cutoff (%) = − 37.2, − 29.5, − 2.9, and 14.4: area under the curve, 0.81, 0.60, 0.56, and 0.56).

Conclusions

Area strain analysis via CMRI may be a more useful tool for assessing the treatment effects of BPA in patients with CTEPH than 2D strains with FTMRI.

Key Points

• Area strain values can detect improvement of right ventricular (RV) pressure and function after balloon pulmonary angioplasty (BPA) equally or more accurately than two-dimensional strains.

• Area strain analysis is a useful analytical method that reflects improvements in complex RV myocardial deformation by BPA.

• Area strain analysis is a robust method with reproducibility equivalent to that of 2D strain analysis.

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Abbreviations

2D:

Two-dimensional

3D:

Three-dimensional

6MWD:

6-min walking distance

ASapex :

Apical area strain

ASbase :

Basal area strain

ASmid :

Middle area strain

BNP:

Brain natriuretic peptide

BPA:

Balloon pulmonary angioplasty

CI:

Cardiac index

CMRI:

Cardiac magnetic resonance imaging

CS:

Circumferential strain

CTEPH:

Chronic thromboembolic pulmonary hypertension

EDV:

End-diastolic volume

EF:

Ejection fraction

ESV:

End-systolic volume

FTMRI:

Feature-tracking magnetic resonance imaging

GAS:

Global area strain

ICC:

Intraclass correlation coefficient

IQR:

Interquartile range

IVS:

Interventricular septum

LS:

Longitudinal strain

LV:

Left ventricular

mPAP:

Mean pulmonary artery pressure

PVR:

Pulmonary vascular resistance

RHC:

Right heart catheterization

ROC:

Receiver operating characteristic

RS:

Radial strain

RV:

Right ventricular

SSFP:

Steady-state free precession

SVi:

Stroke volume index

TAPSE:

Tricuspid annular plane systolic excursion

TE:

Echo time

TR:

Repetition time

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Funding

This work was supported by JSPS KAKENHI Grant Number JP16K19860 and by Kyushu University Research Activity Support Program Foreign language Proofreading Expenses Support.

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Authors and Affiliations

  1. Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka-shi, Fukuoka, Japan

    Masateru Kawakubo & Hidetake Yabuuchi

  2. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka-shi, Fukuoka, Japan

    Yuzo Yamasaki, Takeshi Kamitani, Koji Sagiyama, Yuko Matsuura, Takuya Hino & Hiroshi Honda

  3. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka-shi, Fukuoka, Japan

    Kohtaro Abe & Kazuya Hosokawa

Authors
  1. Masateru Kawakubo
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Correspondence to Masateru Kawakubo.

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The scientific guarantor of this publication is Hiroshi Honda.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Written informed consent was obtained from all subjects (patients) in this study.

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Kawakubo, M., Yamasaki, Y., Kamitani, T. et al. Clinical usefulness of right ventricular 3D area strain in the assessment of treatment effects of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: comparison with 2D feature-tracking MRI. Eur Radiol 29, 4583–4592 (2019). https://doi.org/10.1007/s00330-019-6008-3

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