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Introduction: Both echocardiography and CMR imaging are used to quantify longitudinal function. Inter-method variability for mitral (MAPSE) and tricuspid (TAPSE) annular plane systolic excursion, and variability between directly measured MAPSE and TAPSE and as based on atrioventricular plane displacement (AVPD) analysis by CMR, are, however, not known. This study, therefore, assessed inter-method variability and variability between annular plane systolic excursion and AVPD-based values in a healthy adult population., Methods: Echocardiography and CMR were performed in 111 adults (35 [32-38] years). Method comparisons were assessed with Deming regression, Bland-Altman analysis and coefficient of variation. Observer reproducibility was assessed by the concordance correlation coefficient., Results: Echocardiography and semi-automatic CMR agreed on MAPSE (17 ± 2 mm vs. 17 ± 2 mm, p = 0.1) and TAPSE (25 ± 3 mm vs. 25 ± 3 mm, p = 0.5), correlated highly between methods (fitted-slope 1.22 [95% CI 1.07-1.38] and 1.12 [95% CI 0.95-1.29]) and showed low bias (0.42 [95% CI - 2.05 to 2.88] and - 0.18 [95% CI - 4.78 to 4.43]). Intra-/inter-observer reproducibility was high for both methods for both MAPSE (echocardiography 0.96/0.86; CMR 0.87/0.85) and TAPSE (echocardiography 0.96/0.95; CMR 0.97/0.96). MAPSE (16 ± 2 mm vs. 17 ± 2 mm; p < 0.001) and TAPSE (24 ± 3 vs. 25 ± 3 mm; p < 0.001) based on AVPD were similar but statistically different compared with semi-automatic CMR., Conclusions: Echocardiography and semi-automatic CMR have low variability and provide similar values for MAPSE and TAPSE and are thus interchangeable for follow-up studies. Lateral values based on tracked data from AVPD analysis are not clinically significantly different and could be used as a representation of annular displacement., (© 2021 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.)

Background: In adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, resulting in a poor prognosis. In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) measured by right heart catheterization (RHC) represents a promising index for RV function. The aim of the present study was to comprehensively evaluate non-invasive measures to calculate RVSWI derived by echocardiography (RVSWI ECHO ) using RHC (RVSWI RHC ) as a reference in adult PAH patients., Methods: Retrospectively, 54 consecutive treatment naïve patients with PAH (65 ± 13 years, 36 women) were analyzed. Echocardiography and RHC were performed within a median of 1 day [IQR 0-1 days]. RVSWI RHC was calculated as: (mean pulmonary arterial pressure (mPAP)-mean right atrial pressure (mRAP)) x stroke volume index (SVI) RHC . Four methods for RVSWI ECHO were evaluated: RVSWI ECHO-1  = Tricuspid regurgitant maximum pressure gradient (TR maxPG ) x SVI ECHO , RVSWI ECHO-2  = (TR maxPG -mRAP ECHO ) x SVI ECHO , RVSWI ECHO-3  = TR mean gradient (TR meanPG ) x SVI ECHO and RVSWI ECHO-4  = (TR meanPG -mRAP ECHO ) x SVI ECHO . Estimation of mRAP ECHO was derived from inferior vena cava diameter., Results: RVSWI RHC was 1132 ± 352 mmHg*mL*m -2 . In comparison with RVSWI RHC in absolute values, RVSWI ECHO-1 and RVSWI ECHO-2 was significantly higher (p < 0.001), whereas RVSWI ECHO-4 was lower (p < 0.001). No difference was shown for RVSWI ECHO-3 (p = 0.304). The strongest correlation, with RVSWI RHC , was demonstrated for RVSWI ECHO-2 (r = 0.78, p < 0.001) and RVSWI ECHO-1 ( r = 0.75, p < 0.001). RVSWI ECHO-3 and RVSWI ECHO-4 had moderate correlation (r = 0.66 and r = 0.69, p < 0.001 for all). A good agreement (ICC) was demonstrated for RVSWI ECHO-3 (ICC = 0.80, 95% CI 0.64-0.88, p < 0.001), a moderate for RVSWI ECHO-4 (ICC = 0.73 , 95% CI 0.27-0.87, p < 0.001) and RVSWI ECHO-2 (ICC = 0.55, 95% CI - 0.21-0.83, p < 0.001). A poor ICC was demonstrated for RVSWI ECHO-1 (ICC = 0.45, 95% CI - 0.18-0.77, p < 0.001). Agreement of absolute values for RVSWI ECHO-1 was - 772 ± 385 (- 50 ± 20%) mmHg*mL*m -2 , RVSWI ECHO-2 - 600 ± 339 (-41 ± 20%) mmHg*mL*m -2 , RVSWI ECHO-3 42 ± 286 (5 ± 25%) mmHg*mL*m -2 and for RVSWI ECHO-4 214 ± 273 (23 ± 27%) mmHg*mL*m -2 ., Conclusion: The correlation with RVSWI RHC was moderate to strong for all echocardiographic measures, whereas only RVSWI ECHO-3 displayed high concordance of absolute values. The results, however, suggest that RVSWI ECHO-1 or RVSWI ECHO-3 could be the preferable echocardiographic methods. Prospective studies are warranted to evaluate the clinical utility of such measures in relation to treatment response, risk stratification and prognosis in patients with PAH.

Background: Right ventricular (RV) function is a major determinant of outcome in patients with pulmonary hypertension. Cardiac magnetic resonance (CMR) is gold standard to assess RV ejection fraction (RVEF CMR ), however this is a crude measure. New CMR measures of RV function beyond RVEF CMR have emerged, such as RV lateral atrio-ventricular plane displacement (AVPD lat ), maximum emptying velocity (S' CMR ), RV fractional area change (FAC CMR ) and feature tracking of the RV free wall (FWS CMR ). However, it is not fully elucidated if these CMR measures are in parity with the equivalent echocardiography-derived measurements: tricuspid annular plane systolic excursion (TAPSE), S'-wave velocity (S' echo ), RV fractional area change (FAC echo ) and RV free wall strain (FWS echo ). The aim of this study was to compare regional RV function parameters derived from CMR to their echocardiographic equivalents in patients with pulmonary hypertension and to RVEF CMR ., Methods: Fifty-five patients (37 women, 62 ± 15 years) evaluated for pulmonary hypertension underwent CMR and echocardiography. AVPD lat , S' CMR , FAC CMR and FWS CMR from cine 4-chamber views were compared to corresponding echocardiographic measures and to RVEF CMR delineated in cine short-axis stack., Results: A strong correlation was demonstrated for FAC whereas the remaining measurements showed moderate correlation. The absolute bias for S' was 2.4 ± 3.0 cm/s (relative bias 24.1 ± 28.3%), TAPSE/AVPD lat 5.5 ± 4.6 mm (33.2 ± 25.2%), FWS 4.4 ± 5.8% (20.2 ± 37.5%) and for FAC 5.1 ± 8.4% (18.5 ± 32.5%). In correlation to RVEF CMR, FAC CMR and FWS echo correlated strongly, FAC echo , AVPD lat , FWS CMR and TAPSE moderately, whereas S' had only a weak correlation., Conclusion: This study has demonstrated a moderate to strong correlation of regional CMR measurements to corresponding echocardiographic measures. However, biases and to some extent wide limits of agreement, exist between the modalities. Consequently, the equivalent measures are not interchangeable at least in patients with pulmonary hypertension. The echocardiographic parameter that showed best correlation with RVEF CMR was FWS echo . At present, FAC echo and FWS echo as well as RVEF CMR are the preferred methods to assess and follow up RV function in patients with pulmonary hypertension. Future investigations of the CMR right ventricular measures, beyond RVEF, are warranted.

Background: Right ventricular (RV) systolic function is an important determinant of outcome in patients with pulmonary hypertension (PH). Conventional echocardiographic measures of RV are mainly based on longitudinal contractility. Recently, measurement of RV global longitudinal strain derived from multiple windows (RVGLS) has emerged as an option but has not been well evaluated. The aim of the present study was to evaluate which echocardiographic RV function parameter correlates best with RV ejection fraction derived from cardiac magnetic resonance imaging (RVEF CMR )., Methods and Results: Fifty-five patients evaluated for PH underwent RV assessment with echocardiography and CMR. Conventional echocardiographic parameters of RV function including tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (S'), RV fractional area change (RVFAC) and RV index of myocardial performance (RIMP). RVGLS was measured from three separate apical views using a 17-segment model and strain from the lateral free wall was calculated separately (RVfree). The study included 55 patients, whereas assessment of RVGLS could be obtained in 29 patients. The Pearson correlation coefficient with RVEF CMR was strong for RVGLS (r = 0·814, P<0·001) and RVfree (r = 0·778, P<0·001), modest for RVFAC (r = 0·681, P<0·001), TAPSE (r = 0·592, P<0·001) and RIMP (r=-0·521, P<0·01), and weak for S' (r = 0·385, P<0·01)., Conclusion: The echocardiographic RV measures, RVGLS and RVfree correlated well with RVEF CMR , whereas correlation with TAPSE, RIMP and S' was unsatisfactory. Our findings suggest that RVGLS and RVfree are the preferred echocardiographic methods for clinical practice. RVfree is easiest to perform but RVGLS could provide incremental value in selected patients., (© 2018 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.)

Aims: A cut-off of 9.8% maximum speckle-tracking radial strain in the segment with the latest mechanical delay has been proposed as predictive for selecting the best left ventricular lead placement for positive response on cardiac resynchronization therapy (CRT). However, pacing transmural scar should be avoided, and the purpose of this study was to evaluate the ability of echocardiographic radial strain to predict the presence of scar in the left ventricle segments., Methods and Results: A total of 404 left ventricular segments were analysed, from 34 patients eligible for CRT. Pre-operative cardiac magnetic resonance (CMR) and echocardiography were performed, and maximal strain values from echocardiography speckle tracking were compared with CMR data. Hypokinesia and strain values showed a strong correlation (P < 0.001). Even though segments with CMR-verified scar had lower strain values than segments without scar (14.8 ± 7 vs. 16.0 ± 10), the predictive value of the proposed 9.8% cut-off was low (sensitivity 33% and specificity 72%). Scar burden was higher in ischaemic patients (13.5 vs. 5.3% P = 0.0001). Relative difference in strain values (target segment strain compared with the average strain value of the adjacent segments) was higher if there was transmural scar in the target segment as compared with a hypokinetic but viable target segment (87 vs. 38% difference, P = 0.03)., Conclusion: Speckle tracking radial strain should ideally be complemented by CMR for accurate assessment of viability, especially for patients with ischaemic aetiology of heart failure where transmural scar is more common. Comparison of strain values with the adjacent segments may be helpful for assessing viability., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)

Aims: To evaluate the feasibility and incremental value of using an integrated bullseye model for presenting data from cardiac computed tomography (CT) and magnetic resonance imaging (MRI) in combination with echocardiography evaluation of segmental mechanical delay for guiding optimal left ventricular lead placement in cardiac resynchronization therapy (CRT)., Methods and Results: Thirty-nine patients (69 ± 9.7 years, 77% male, 82% with LBBB, 54% with ischaemic cardiomyopathy, 82% New York Heart Association classification of heart failure III) eligible for CRT were included. The left ventricular segment with the latest mechanical activation was determined by echocardiography with speckle tracking radial strain. Cardiac CT scan was used for anatomical evaluation of the coronary sinus and its branches. Cardiac MRI was used for evaluation of viability. A composite bullseye plot was constructed, indicating the most appropriate site for left ventricle (LV) lead placement. The latest mechanical delay was in the basal-anterior (3%), basal-inferior (3%), basal-inferolateral (13%), basal-anterolateral (21%), mid-anterior (8%), mid-inferior (3%), mid-inferolateral (34%), and mid-anterolateral (16%) segment. There were on average 2.5 ± 0.8 veins of suitable sizes (≥1.5 mm in diameter). A preoperative combined bullseye plot indicated that in 53% of the patients, there was a matching vein in the segment with the latest mechanical delay. If immediately adjacent segments were included, an optimal placement was possible in 95% of the patients. At 6 months, there was a statistically significant reduction in the left ventricular end systolic volume and the left ventricular ejection fraction was improved (P < 0.01)., Conclusion: Presenting data from echocardiography, cardiac CT, and MRI in a combined bullseye plot is both feasible and convenient for indicating the most appropriate site for LV lead placement. An optimal electrode position can be suggested in almost all patients.