Assessing right ventricular peak strain in myocardial infarction patients with mitral regurgitation by cardiac magnetic resonance feature tracking

Xiaoling Wen; Yue Gao; Yingkun Guo; Yi Zhang; Yan Zhang; Ke Shi; Yuan Li; Zhigang Yang

doi:10.21037/qims-23-1360

Assessing right ventricular peak strain in myocardial infarction patients with mitral regurgitation by cardiac magnetic resonance feature tracking

Quant Imaging Med Surg. 2024 Apr 3;14(4):3018-3032. doi: 10.21037/qims-23-1360. Epub 2024 Mar 28.

Authors

Xiaoling Wen^#^{1

2}, Yue Gao^#¹, Yingkun Guo³, Yi Zhang⁴, Yan Zhang², Ke Shi¹, Yuan Li¹, Zhigang Yang¹

Affiliations

¹ Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
² Department of Radiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
³ Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China.
⁴ Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.

^# Contributed equally.

Abstract

Background: Although it is known that mitral regurgitation (MR) in patients with myocardial infarction (MI) may increase the right ventricular (RV) afterload, leading to RV dysfunction, the exact detrimental effects on RV function and myocardial peak strain remain unresolved. In this study, we assessed the impact of MR on the impairment of RV myocardial deformation in patients with MI and explored the independent influential factors of RV peak strain.

Methods: A total of 199 MI participants without or with MR were retrospectively assessed in this study. The cardiovascular magnetic resonance examination protocol included a late gadolinium-enhanced (LGE) imaging technique and a cine-balanced steady-state free precession sequence. Statistical tests, including two independent sample t-test or Mann-Whitney U-test, analysis of variance, Kruskal-Wallis test, and multiple linear regression analysis models were performed.

Results: The MI (MR+) group exhibited significantly lower RV strain parameters in the radial, circumferential and longitudinal directions when compared to the control and the MI (MR-) groups (both P<0.05). The RV global longitudinal peak strain (GLPS) in the MI group significantly decreased when compared with that in the control group (P<0.05). As moderate-severe MR worsened in patients with MI, RV myocardial global peak strain and the peak systolic strain rate (PSSR) gradually decreased. Multiple linear regression analysis revealed that left ventricular (LV) GLPS, triglycerides, and age were independently correlated with RV GLPS (all P<0.05). RV end-systolic volume (RVESV) acted as an independent association factor for RV global peak strain.

Conclusions: MR may exacerbate the impairment of RV peak strain and functions in patients with MI. LV GLPS was positively correlated with RV GLPS. However, RVESV, triglycerides, and age acted as independent risk factors associated with worsening RV GLPS.

Keywords: Myocardial infarction (MI); biventricular interaction; cardiac magnetic resonance feature tracking (CMR-FT); mitral regurgitation (MR); right ventricular strain (RV strain).