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

• Published in: European radiology Vol. 29; no. 9; pp. 4583 - 4592
• Main Authors: Kawakubo, Masateru, Yamasaki, Yuzo, Kamitani, Takeshi, Sagiyama, Koji, Matsuura, Yuko, Hino, Takuya, Abe, Kohtaro, Hosokawa, Kazuya, Yabuuchi, Hidetake, Honda, Hiroshi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2019; Springer Nature B.V
• Subjects: Aged; Angioplasty; Angioplasty, Balloon - methods; Balloon treatment; Cardiac; Deformation; Diagnostic Radiology; Female; Heart; Heart Ventricles - physiopathology; Humans; Hypertension; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Hypertension, Pulmonary - therapy; Imaging; Imaging, Three-Dimensional - methods; Internal Medicine; Interventional Radiology; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Patients; Pulmonary arteries; Pulmonary artery; Pulmonary Embolism - complications; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - physiopathology; Pulmonary Embolism - therapy; Pulmonary hypertension; Radiology; Reproducibility; Reproducibility of Results; Retrospective Studies; ROC Curve; Strain analysis; Thromboembolism; Tracking; Two dimensional analysis; Ultrasound; Ventricle; Ventricular Function, Right - physiology; Balloon angioplasty; Cine magnetic resonance imaging; Myocardial contraction; Right ventricle; Pulmonary heart disease
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-019-6008-3

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
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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.
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Area strain analysis is a useful analytical method that reflects improvements in complex RV myocardial deformation by BPA
.
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Area strain analysis is a robust method with reproducibility equivalent to that of 2D strain analysis.