Manual long axis strain showed strong correlation with automated feature-tracking and equal diagnostic accuracy (AUC 0.81 vs 0.81, p=0.89) to identify left heart disease at rest in patients with pulmonary hypertension.
Observational (n=209)
No
Does manual long axis strain (LAS) provide comparable diagnostic accuracy to automated feature-tracking (FT) deformation imaging for identifying left heart disease in patients with pulmonary hypertension?
Manual long axis strain is a fast, software-independent alternative to feature-tracking for detecting overt left heart disease in pulmonary hypertension at rest, though feature-tracking remains superior for detecting masked left heart disease during exercise stress.
Effect estimate: AUC 0.81
Absolute Event Rate: 0.81% vs 0.81%
p-value: p=0.89
Left heart disease (LHD) may cause or coexist in pulmonary hypertension (PH). Left atrial (LA) deformation identifies LHD in PH, however, feature-tracking (FT) deformation imaging remains underused due to limited inter-vendor agreement. Manual long axis strain (LAS) has been introduced as a software independent approach for deformation assessment. Consequently, we sought to compare their diagnostic accuracies for identification of LHD in PH. Patients referred to both right heart catheterisation (RHC) and cardiovascular magnetic resonance (CMR) imaging were enrolled in this monocentric registry. Patients were classified by RHC according to current guideline recommendations. CMR assessment included FT-deformation imaging for LA total strain (Es) and left ventricular (LV) global longitudinal strain (GLS) as well as LV/LA LAS. In total n = 209 PH patients were included with n = 126 undergoing exercise-stress testing (n = 55 normal, n = 72 pre-capillary, n = 27 combined post-/precapillary, n = 15 isolated postcapillary, n = 34 exercise and n = 6 unclassified PH). LAS showed strong correlation with FT for both LA (r = 0.78, p 2 (AUC = 0.66 vs. 0.73, p = 0.045) but significantly inferior to LA Es. LV LAS showed similar performance compared to LV GLS, but worse compared to LA LAS. Software-independent LAS shows strong correlation to its FT counterparts and good diagnostic accuracy for detection of LHD in PH. However, for detection of masked LHD detected during exercise-stress only, FT LA Es remains the most accurate parameter.
Schmermund et al. (Thu,) conducted a observational in Patients with pulmonary hypertension evaluated for left heart disease including normal hemodynamics, and subtypes precapillary, combined post-/precapillary, isolated postcapillary, exercise-induced, and unclassified PH (n=209). Manual long axis strain (LAS) vs. Automated feature-tracking (FT) deformation imaging for left atrial reservoir strain (Es) and left ventricular global longitudinal strain (GLS) was evaluated on Identification of left heart disease (LHD) defined invasively by pulmonary capillary wedge pressure (PCWP) thresholds at rest and during exercise stress using deformation imaging parameters (AUC 0.81, p=0.89). Manual long axis strain showed strong correlation with automated feature-tracking and equal diagnostic accuracy (AUC 0.81 vs 0.81, p=0.89) to identify left heart disease at rest in patients with pulmonary hypertension.
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