Quantitative analysis of three-dimensional left ventricular global strain using coronary computed tomography angiography in patients with heart failure: Comparison with 3T cardiac MR

Purpose The objective of this study was to investigate whether three dimentional (3D)- Coronary CT angiography (CCTA)- feature tracking (FT) can measure global myocardial strain of the left ventricle (LV) in patients with heart failure using cardiac MR (CMR) as reference. Methods Consecutive patients (n = 44) with variable degrees of heart failure who underwent an ECG-gated CCTA and CMR within 24 h were included. Both modalities were compared for 2D/3D LV global radial strain (2D/3D-GRS), circumferential strain (2D/3D-GCS), longitudinal strain (2D/3D-GLS) and conventional functional parameters. Results Compared to CMR, CCTA-derived 3D-GLS and LVEF showed no significant difference (p > 0.05). Bland-Altman plots showed a small bias (0.3 %) between CCTA-derived 3D-GLS and CMR 3D-GLS. Close correlations were observed between the two modalities regarding LV global strain (3D-GRS, r = 0.89; 3D-GCS, r = 0.86; 3D-GLS, r = 0.79, respectively, p < 0.001 for all). However, CCTA-derived 3D-GRS and 3D-GCS were statistically different compared with CMR. CCTA-derived 3D-GLS had an inverse correlation with CCTA-LVEF(r=-0.75, p < 0.05). Intraobserver agreements for CCTA-derived 3D-global strain were good (ICC = 0.856 for 3D-GLS, ICC = 0.741 for 3D-GCS and ICC = 0.762 for 3D-GRS). 2D global strain showed statistical differences between the two modalities (p＜0.05 for all), but close correlations were observed regarding 2D LV global strain (2D-GRS, r = 0.80; 2D-GCS, r = 0.81; 2D-GLS, r = 0.81, respectively, p < 0.001 for all). The average radiation dose-long-product (DLP) of CCTA was 387.86 ± 89.3 mGy*cm. Conclusion CCTA-derived 3D-GLS can provide both reliable and interchangeable results for quantitative assessment of myocardial mechanical changes in HF patients compared to CMR with good intra-observer agreement.