Characteristics of the left ventricular three-dimensional maximum principal strain using cardiac computed tomography: reference values from subjects with normal cardiac function

• Published in: European radiology Vol. 30; no. 11; pp. 6109 - 6117
• Main Authors: Yoshida, Kazuki, Tanabe, Yuki, Kido, Teruhito, Kurata, Akira, Uraoka, Daichi, Kinoshita, Masaki, Uetani, Teruyoshi, Nishimura, Kazuhisa, Inoue, Katsuji, Ikeda, Shuntaro, Yamaguchi, Osamu, Mochizuki, Teruhito
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2020
• Subjects: Cardiac; Diagnostic Radiology; Echocardiography - methods; Electrocardiography; Female; Heart Ventricles - diagnostic imaging; Humans; Imaging; Internal Medicine; Interventional Radiology; Male; Medicine; Medicine & Public Health; Middle Aged; Myocardial Contraction - physiology; Neuroradiology; Radiology; Reference Values; Retrospective Studies; Stroke Volume - physiology; Tomography, X-Ray Computed - methods; Ultrasound; Ventricular Function, Left - physiology; Computed tomography angiography; Myocardium; Computed tomography; Elasticity imaging techniques; Stroke volume
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-020-07001-6

Objectives This study evaluated the characteristics of left ventricular maximum principal strain (LV-MPS) using cardiac CT in subjects with normal LV function. Methods Of 973 subjects who underwent retrospective electrocardiogram-gated cardiac CT using a third-generation dual-source CT without beta-blocker administration, 31 subjects with preserved LV ejection fraction ≥ 55% assessed by echocardiography without coronary artery stenosis and cardiac pathology were retrospectively identified. CT images were reconstructed every 5% (0–95%) of the RR interval. LV-MPS and the time to peak (TTP) were analyzed using the 16-segment model and compared among three levels (base, mid, and apex) and among four regions (anterior, septum, inferior, and lateral) using the Steel–Dwass test. The intra- and inter-observer reproducibilities for LV-MPS were calculated using intraclass correlation coefficients (ICCs). Results The intra- and inter-observer ICCs (95% confidence interval) for peak LV-MPS were 0.96 (0.94–0.97) and 0.94 (0.92–0.96), respectively. The global peak LV-MPS (median, inter-quantile range) was 0.59 (0.55–0.72). The regional LV-MPS significantly increased in the order of the basal (0.54, 0.49–0.59), mid-LV (0.57, 0.53–0.65), and apex (0.68, 0.60–0.84) ( p  < 0.05, in each), and was significantly higher in the lateral wall (0.66, 0.60–0.77), while that in the septal region (0.47, 0.44–0.54) was the lowest among the four LV regions (all p  < 0.05). No significant difference in TTP was seen among the myocardial levels and regions. Conclusion CT-derived LV-MPS is reproducible and quantitatively represents synchronized myocardial contraction with heterogeneous values in subjects with normal LV function. Key Points • CT-derived left ventricular maximum principal strain analysis allows highly reproducible quantitative assessments of left ventricular myocardial contraction. • In subjects with normal cardiac function, the peak value of CT-derived left ventricular maximum principal strain is the highest in the apical level and in the lateral wall and the lowest in the septum. • The regional peak left ventricular maximum principal strain shows intra-ventricular heterogeneity on a per-patient basis, but myocardial contraction is globally synchronized in subjects with normal cardiac function seen on cardiac CT.