A Head-to-head Comparison of CMR Tagging, CMR Feature Tracking and Speckle Tracking Echocardiography in the Prediction of Cardiac Resynchronization Therapy Outcome

摘要

Purpose: Myocardial strain imaging is a potential tool to improve patient selection for cardiac resynchronization therapy (CRT). Multiple imaging modalities are presently available including CMR myocardial tagging (CMR-TAG), CMR feature tracking (CMR-FT) and speckle tracking echocardiography (STE). Despite promising results per imaging modality, a direct comparison between these methods is lacking. This study aims (i) to compare the predictive value of different strain parameters, and (ii) to evaluate the predictive performance per imaging modality. Methods: As part of the MARC study, patients were prospectively enrolled and underwent both CMR and echocardiographic examination before CRT implantation. Strain analysis was performed with dedicated software in the circumferential (CMR-TAG, CMR-FT and STE-circ) and longitudinal (STE-long) orientation. Basic strains, mechanical timing differences (dyssynchrony) and inefficient contraction patterns (discoordination) were quantified. After twelve months, CRT response was quantified by the echocardiographic change in left ventricular end-systolic volume (LVESV). Results: Twenty-six patients (age 65±9 y, 15 men) completed follow-up. Using CMR-TAG, various strain markers were strongly associated with LVESV change including segmental dyssynchrony (SD-TTPLV) and segmental discoordination (ISFLV), see figure. Both CMR-FT and STE showed weaker correlations for most parameters, but still showed a good correlation by measuring regional discoordination (ISFsep-lat). Overall, systolic septum strain (AVC strainsep) showed the strongest correlation with LVESV change. Conclusion: CMR-TAG demonstrates the highest predictive performance compared to other imaging techniques. CMR-FT and STE yield reasonable performance as well and might be more accessible in clinical practice. Overall, the basic AVC strainsep marker demonstrates the strongest correlation with CRT response