Three-Dimensional Myocardial Strain Evaluation Using Computed Tomography

Overview

This study evaluates the agreement and reproducibility of three-dimensional (3D) myocardial strain assessment using computed tomography (CT) compared to two-dimensional (2D) transthoracic echocardiography (TTE) in patients with severe aortic stenosis (AS). It highlights the relationship between myocardial strain and pulmonary hypertension (PH), demonstrating that CT-derived strain parameters can effectively identify PH in this patient population.

Background

Aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries, often leading to significant morbidity and mortality. Accurate assessment of myocardial strain is crucial for evaluating cardiac function and guiding treatment decisions, particularly in patients undergoing transcatheter aortic valve implantation (TAVI). The integration of 3D strain analysis from CT may enhance risk stratification and improve patient outcomes.

Data Highlights

Key Findings

• Strong agreement between CT and TTE for LV-GLS (r = 0.837) and RV-GLS (r = 0.853).
• Peak longitudinal strain was significantly reduced in patients with high probability pulmonary hypertension (H-PH) compared to low probability (L-PH) (p < 0.001).
• Optimal strain cutoff values for identifying H-PH were lower on CT than on TTE.
• TTE-derived LV-GLS was superior to CT-derived LV-GLS for detecting H-PH (AUC: 0.94 vs. 0.85, p = 0.013).
• Both TTE and CT-derived strain measurements showed excellent reproducibility (ICC > 0.9).

Clinical Implications

The findings suggest that CT-derived 3D myocardial strain assessment can serve as a valuable adjunct to TTE in evaluating patients with severe AS, particularly in identifying those at risk for pulmonary hypertension. Clinicians may consider incorporating CT strain analysis into routine pre-TAVI evaluations to enhance risk stratification and optimize patient management.

Conclusion

Three-dimensional myocardial strain evaluation using CT is a promising tool that complements traditional echocardiographic methods, potentially improving the assessment of cardiac function in patients with severe aortic stenosis. Further research is needed to establish its prognostic value.

Related Resources & Content

1. Clinical Research in Cardiology, 2017 -- Assessment of Longitudinal Strain via Cardiac Magnetic Resonance Relates to Hemodynamic Parameters in Severe Aortic Stenosis Patients and Forecasts Positive Remodeling Post-Transcatheter Aortic Valve Replacement
2. Clinical Research in Cardiology, 2023 -- The Relationship Between Low-Flow and Left Ventricular Function in Aortic Stenosis Patients with Diminished Ejection Fraction
3. Pediatric Cardiology, 2017 -- Longitudinal Myocardial Strain Fails to Predict Ejection Fraction in Children with Total Cavopulmonary Connection as Evaluated by Cardiac MRI
4. 2025 ESC/EACTS Guidelines for the management of valvular heart disease | European Heart Journal - Valvular and Structural Heart Disease | Oxford Academic
5. Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis - PubMed
6. Pediatric Cardiology — Sustained Myocardial Deformation Following Successful Repair of Coarctation: Insights from a CMR Feature-Tracking Analysis
7. 2025 ESC/EACTS Guidelines for the management of valvular heart disease
8. Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis - PubMed
9. https://kjronline.org/pdf/10.3348/kjr.2024.1261