Echocardiographic assessment of left bundle branch–related strain dyssynchrony: a comparison with tagged MRI

Louis S. Fixsen (Corresponding author), Anouk G.W. de Lepper, Marc Strik, Lars B. van Middendorp, Frits W. Prinzen, Frans N. van de Vosse, Patrick Houthuizen, Richard G.P. Lopata

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Recent studies have shown the efficacy of myocardial strain estimated using speckle tracking echocardiography (STE) in predicting response to cardiac resynchronisation therapy. This study focuses on circumferential strain patterns, comparing STE-acquired strains to tagged-magnetic resonance imaging (MRI-T). Second, the effect of regularisation was examined. Two-dimensional parasternal ultrasound (US) and MRI-T data were acquired in the left ventricular short-axis view of canines before (n = 8) and after (n = 9) left bunch branch block (LBBB) induction. US-based strain analysis was performed on Digital Imaging and Communications in Medicine data at the mid-level using three overall methods (“Commercial software,” “Basic block-matching,” “regularised block-matching”). Moreover, three regularisation approaches were implemented and compared. MRI-T analysis was performed using SinMod. Normalised regional circumferential strain curves, based on standard six or septal/lateral segments, were analysed and cross-correlated with MRI-T data. Systolic strain (SS) and septal rebound stretch (SRS) were calculated and compared. Overall agreement of normalised circumferential strain was good between all methods on a global and regional level. All STE methods showed a bias (≥4% strain) toward higher SS estimates. Pre-LBBB, septal and lateral segment correlation was excellent between the Basic (mean ρ = 0.96) and regularised (mean ρ = 0.97) methods and MRI-T. The Commercial method showed a significant discrepancy between the two walls (septal ρ = 0.94, lateral ρ = 0.68). Correlation with MRI-T reduced between pre- and post-LBBB (Commercial ρ = 0.79, Basic ρ = 0.82, mean regularised ρ = 0.86). Septal strain patterns and SRS varied with the STE software and type of regularisation, with all STE methods estimating non-zero SRS values pre-LBBB. Absolute values showed moderate agreement, with a bias for higher strain from STE. SRS varied with the type of software and extra regularisation applied. Open efforts are needed to understand the underlying causes of differences between STE methods before standardisation can be achieved. This is particularly important given the apparent clinical value of strain-based parameters such as SRS.

LanguageEnglish
Pages2063-2074
JournalUltrasound in Medicine and Biology
Volume45
Issue number8
Early online date3 May 2019
DOIs
StatePublished - 1 Aug 2019

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echocardiography
bundles
Echocardiography
Software
computer programs
Cardiac Resynchronization Therapy
speckle patterns
standardization
medicine
magnetic resonance
Canidae
therapy
induction
estimating
communication
Magnetic Resonance Imaging
Medicine
causes
curves
estimates

Keywords

  • Dyssynchrony
  • Echocardiography
  • LBBB
  • Regularisation
  • Speckle tracking

Cite this

Fixsen, Louis S. ; de Lepper, Anouk G.W. ; Strik, Marc ; van Middendorp, Lars B. ; Prinzen, Frits W. ; van de Vosse, Frans N. ; Houthuizen, Patrick ; Lopata, Richard G.P./ Echocardiographic assessment of left bundle branch–related strain dyssynchrony : a comparison with tagged MRI. In: Ultrasound in Medicine and Biology. 2019 ; Vol. 45, No. 8. pp. 2063-2074
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abstract = "Recent studies have shown the efficacy of myocardial strain estimated using speckle tracking echocardiography (STE) in predicting response to cardiac resynchronisation therapy. This study focuses on circumferential strain patterns, comparing STE-acquired strains to tagged-magnetic resonance imaging (MRI-T). Second, the effect of regularisation was examined. Two-dimensional parasternal ultrasound (US) and MRI-T data were acquired in the left ventricular short-axis view of canines before (n = 8) and after (n = 9) left bunch branch block (LBBB) induction. US-based strain analysis was performed on Digital Imaging and Communications in Medicine data at the mid-level using three overall methods (“Commercial software,” “Basic block-matching,” “regularised block-matching”). Moreover, three regularisation approaches were implemented and compared. MRI-T analysis was performed using SinMod. Normalised regional circumferential strain curves, based on standard six or septal/lateral segments, were analysed and cross-correlated with MRI-T data. Systolic strain (SS) and septal rebound stretch (SRS) were calculated and compared. Overall agreement of normalised circumferential strain was good between all methods on a global and regional level. All STE methods showed a bias (≥4{\%} strain) toward higher SS estimates. Pre-LBBB, septal and lateral segment correlation was excellent between the Basic (mean ρ = 0.96) and regularised (mean ρ = 0.97) methods and MRI-T. The Commercial method showed a significant discrepancy between the two walls (septal ρ = 0.94, lateral ρ = 0.68). Correlation with MRI-T reduced between pre- and post-LBBB (Commercial ρ = 0.79, Basic ρ = 0.82, mean regularised ρ = 0.86). Septal strain patterns and SRS varied with the STE software and type of regularisation, with all STE methods estimating non-zero SRS values pre-LBBB. Absolute values showed moderate agreement, with a bias for higher strain from STE. SRS varied with the type of software and extra regularisation applied. Open efforts are needed to understand the underlying causes of differences between STE methods before standardisation can be achieved. This is particularly important given the apparent clinical value of strain-based parameters such as SRS.",
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Echocardiographic assessment of left bundle branch–related strain dyssynchrony : a comparison with tagged MRI. / Fixsen, Louis S. (Corresponding author); de Lepper, Anouk G.W.; Strik, Marc; van Middendorp, Lars B.; Prinzen, Frits W.; van de Vosse, Frans N.; Houthuizen, Patrick; Lopata, Richard G.P.

In: Ultrasound in Medicine and Biology, Vol. 45, No. 8, 01.08.2019, p. 2063-2074.

Research output: Contribution to journalArticleAcademicpeer-review

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