Comparison of strain measurement from multimodality tissue tracking with strain-encoding MRI and harmonic phase MRI in pulmonary hypertension Yoshiaki Ohyama a , Bharath Ambale-Venkatesh a , Elzbieta Chamera a , Monda L. Shehata b , Celia P. Corona-Villalobos c , Stefan L. Zimmerman c , Paul M. Hassoun d , David A. Bluemke e , Joao A.C. Lima a, ⁎ a Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA b Mercy Catholic Medical Center, Philadelphia, PA, USA c Division of Radiology, Johns Hopkins University, Baltimore, MD, USA d Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA e National Institutes of Health, Bethesda, MD, USA abstract article info Article history: Received 13 August 2014 Received in revised form 2 December 2014 Accepted 4 January 2015 Available online 6 January 2015 Keywords: Cardiac magnetic resonance Myocardial strain Pulmonary hypertension Background: Pixel-based multimodality tissue tracking (MTT) is a new noninvasive method for the quantification of cardiac deformation from cine image of MRI. The aim of this study is to validate bi-ventricular strain measure- ment by MTT compared to strain-encoding (SENC) MRI and harmonic phase (HARP) MRI in pulmonary hyper- tension (PH) patients. Methods: In 45 subjects (30 PH patients and 15 normal subjects), RV and LV peak global longitudinal strains (Ell) were measured from long axis 4 chamber view using MTT. LV peak global circumferential strains (Ecc) by MTT were measured from short axis. For validation, RV and LV Ell by MTT were compared to measures by SENC- MRI from short axis, and LV Ecc by MTT was compared to measures by short axis tagged MRI analysis (HARP). Reproducibility of MTT was also determined. Results: MTT quantified RV Ell correlated closely to those of SENC (r = 0.72, p b 0.001), with good limits of agree- ment. LV Ell quantified by MTT showed moderate correlation with SENC (r = 0.57, p = 0.001), and LV Ecc by MTT also showed moderate correlation with HARP (−16.9 ± 4.1 vs −14.3 ± 3.5, p b 0.001 for all, r = 0.60, p b 0.001). RV Ell negatively correlated with RVEF (r = −0.53, p = 0.001) and also positively correlated with mean PAP in PH patients (r = 0.60, p = 0.001). Strain measurement by MTT showed high reproducibility. Conclusions: We demonstrate that MTT is a reproducible tool for quantification of cardiac deformation using cine images in PH patients. Hence, it could serve as a new rapid and comprehensive technique for clinical assessment of regional cardiac function. © 2015 Elsevier Ireland Ltd. All rights reserved. 1. Background Pulmonary hypertension (PH) is characterized by increased mean pulmonary artery pressure (PAP) ≥25 mm Hg at rest, which leads to right pressure overload, right heart failure, and ultimately premature death [1,2]. It has become increasingly evident that clinical improve- ment and prolonged survival in PH are highly dependent on preserved right ventricle (RV) function [3]. The RV and left ventricle (LV) share the interventricular septum (IVS) and are contained within the same pericardial sac, which leads to interventricular dependence; thus, RV pressure and volume loads cause leftward septal bowing, resulting in al- tered LV filling dynamics and function [4]. Recently, it has been reported that reduced biventricular regional function is associated with increased RV afterload [5,6]. Thus, biventricular assessment and follow-up in PH patients are critical. Recent developed cardiovascular imaging modality such as echocar- diography and cardiac magnetic resonance can allow for assessment for detailed cardiac structure and function [7,8]. LV and RV regional func- tion can be assessed from cardiac magnetic resonance (CMR) imaging through myocardial tagging [9–11] as well as real-time myocardial strain encoding (SENC) [12,13] or direct tissue encoding sequences (DENSE) [14]. Myocardial tagging and SENC have quantitative value, but have not yet gained widespread clinical use, in part because of International Journal of Cardiology 182 (2015) 342–348 Abbreviations: PH, pulmonary hypertension;RV,rightventricle;LV,leftventricle;HARP, harmonic phase analysis; MTT, multimodality tissue tracking; SENC, strain-encoding; Ell, longitudinal strain; Ecc, circumferential strain. ⁎ Corresponding author at: 600N. Wolf Street/Blalock 524, Baltimore, MD 21287, USA. E-mail addresses: yohyama1@jhmi.edu (Y. Ohyama), bambale1@jhmi.edu (B. Ambale-Venkatesh), echamer1@jhmi.edu (E. Chamera), mondashehata@gmail.com (M.L. Shehata), ccorona1@jhmi.edu (C.P. Corona-Villalobos), stefan.zimmerman@jhmi.- edu (S.L. Zimmerman), phassou1@jhmi.edu (P.M. Hassoun), bluemked@cc.nih.gov (D.A. Bluemke), jlima@jhmi.edu (J.A.C. Lima). http://dx.doi.org/10.1016/j.ijcard.2015.01.016 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard