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Rapid Fire Abstracts

Rapid Fire 04- Heart Failure I

Quantification of Left Ventricular Diastolic Strain and Strain Rate in Heart Failure with Preserved Ejection Fraction Using Cine DENSE (RF_TH_267)

Thursday, January 30, 2025
5:50 PM – 6:00 PM East Coast USA Time
Location: Blue Room PreFunction
Background: The current gold standard for diagnosing heart failure with preserved ejection fraction (HFpEF) involves the presence of heart failure signs and symptoms, preserved left ventricular (LV) ejection fraction (EF >50%)1, and elevated LV diastolic pressure2. Due to the high variability in noninvasive measurements of LV filling pressure, 2D echocardiography is limited in accurately identifying HFpEF compared to invasive exercise testing2. Impaired LV global longitudinal and circumferential strain has shown promise as a sensitive non-contrast biomarker for diagnosing HFpEF patients using feature tracking3 and echocardiography4,5. CINE Displacement Encoding with Stimulated Echoes (DENSE) has demonstrated the ability to produce highly reproducible strain measurements6. Thus, our objectives were: 1) To characterize global strain and strain rate in HFpEF patients using cine DENSE; and 2) To evaluate a regression model that includes strain and strain rate to differentiate between healthy controls and HFpEF patients.

Methods:

HFpEF patients (N=6, 72±16 years old) and healthy controls (N=7, 62±7 years old), were prospectively enrolled in an IRB-approved study, consented, and underwent a 3T (Skyra/Vida, Siemens) CMR exam. Single-slice, short-axis, mid-ventricular data was acquired using breath-hold cine DENSE (2x2x8 mm3, TE/TRes=1.08/15ms, ke=0.08cycles/mm, Navg=1, ~20s/slice)7. Global radial (Err) and circumferential strains (Ecc) were computed using the DENSE analysis tool8,9. The systolic strain rate was defined as the slope of the strain curve from the 1st cardiac frame to 90% of the peak-systolic strain (Line A in Fig. 1). The early-diastolic strain rate was defined as the slope over the duration from 90% of the end-systole to mid-diastole (Line B in Fig. 1). LV volumes and function were calculated from standard bSSFP cine images. Group-wise differences were tested by a Wilcoxon rank-sum test. Data is reported as median (IQR) and p< 0.05 was considered significant. Lastly, a binomial logistic regression model tested whether Ecc, systolic Ecc/s, and early-diastolic Ecc/s can distinguish between healthy controls and HFpEF patients.

Results: HFpEF patients were significantly heavier, resulting in significantly higher BMI and BSA compared to healthy controls (Table 1). HFpEF patients had significantly lower LVEDVi compared to healthy controls [68(28) vs 96(23), p=0.024]. There was no statistically significant difference in Err, systolic Err/s, and early-diastolic Err/s between HFpEF patients and healthy controls (Fig. 2). However, HFpEF patients exhibited significantly impaired Ecc [-0.14(0.04) vs -0.19(0.04), p=0.011], systolic Ecc/s [-0.56(0.09) vs -0.75(0.16), p=0.014], and early-diastolic Ecc/s [0.39(0.14) vs 0.92(0.35), p=0.001] compared to healthy controls (Figure 2). Early-diastolic Ecc/s best distinguished between HFpEF patients and healthy controls (AUC=1), followed by a combination of Ecc and systolic Ecc/s (AUC=0.98), and Ecc (AUC=0.88).

Conclusion:

HFpEF patients exhibited significantly reduced Ecc and Ecc/s compared to healthy controls, which has been observed previously using echocardiography speckle tracking5,10. The impairment may be indicative of a compensatory mechanism employed by HFpEF hearts to sustain normal ejection fraction. Ecc, systolic Ecc/s, and early-diastolic Ecc/s could be used to distinguish HFpEF patients from healthy controls and may serve as non-invasive biomarkers with high reproducibility for screening HFpEF patients.