Validation of Feature-Tracking Cardiac CT for Left Ventricular Strain Assessment in Pediatric Acute Myocarditis: Comparison With Cardiac MRI.

Role of feature tracking cardiac MRI in evaluation of ischemic cardiomyopathy

Ischemic cardiomyopathy (ICM) is characterized by profound left ventricular (LV) remodelling, impaired systolic function, and variable myocardial viability. Cardiac magnetic resonance feature tracking (CMR-FT) enables non-invasive quantification of myocardial deformation from standard cine sequences without dedicated tagging sequences. The present study aimed to evaluate the role of CMR-FT in the comprehensive assessment of myocardial function and viability in patients with ICM compared with healthy controls. Cases showed markedly elevated end-diastolic and end-systolic volumes with severely reduced ejection fraction (EF: 36.6 ± 16.9% vs. 64.1 ± 10.0%; p < 0.001). Stroke volume was preserved, reflecting Frank-Starling compensation. Wall motion abnormalities were concentrated in mid-cavity and apical territories. Apical segments demonstrated the highest transmural scar burden on LGE (apex 33.3%; apical inferior 35.3%). All three global strain parameters were profoundly impaired with large effect sizes (GRS Cohen’s d = 2.46; GCS d = 2.00; GLS d = 1.38). Segmental circumferential strain (SCS) and segmental radial strain (SRS) demonstrated statistically significant discriminative ability for non-viable myocardium (AUC 0.624–0.637); segmental longitudinal strain (SLS) reached significance uniquely for viable scar versus no scar (AUC 0.566). CMR-FT provides comprehensive, non-invasive assessment of myocardial deformation in ICM. A multi-strain approach—SCS and SRS for transmural scar identification, SLS for early subendocardial injury—offers clinically meaningful, contrast-independent viability information that complements LGE imaging and supports risk stratification in this population.

Left ventricular myocardial strain analysis by feature tracking cardiac magnetic resonance in patients with autoimmune rheumatic diseases: A case-control study.

Discrimination of sustained VT in structural heart disease using LGE-CMR and computational simulation: moving beyond LVEF

Background Sustained ventricular tachycardia (VT) is a major cause of sudden cardiac death in structural heart disease (SHD). Risk stratification based on left ventricular ejection fraction (LVEF) remains suboptimal. This study aimed to develop an exploratory model integrating late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) scar characteristics with computational VT simulation to discriminate sustained VT, compared against LVEF. Methods In this single-centre retrospective study, consecutive patients with suspected SHD who underwent LGE-CMR were enrolled. Patients with LGE-positive underwent quantitative scar analysis, personalized digital heart-twin reconstruction, and virtual electrophysiological simulation. Results Among 82 patients (mean age 59.1 years; 82.9% male), 15 experienced sustained VT. Lower LVEF was associated with sustained VT (P = 0.008; C-statistic: 0.730), as was visual LGE positivity (P = 0.023; C-statistic: 0.634). Among LGE-positive patients, those with sustained VT had a larger core scar [10.0 [5.9, 14.8]% vs. 2.2 [1.1, 4.7]%; P < 0.001], larger grey zone [14.0 [10.9, 14.7]% vs. 5.7 [2.3, 9.2]%; P < 0.001], higher VT inducibility [50.0 [22.9, 66.9]% vs. 0 (0, 21.1)%; P < 0.001], and a greater number of inducible VT circuits [2 [2, 4] vs. 0 [0, 2]; P < 0.001]. An integrated LGE-VTsim index, derived from these four parameters, effectively discriminated sustained VT (C-statistic: 0.816) and remained independently associated with sustained VT after adjusting for LVEF (OR: 1.029; 95% CI: 1.008–1.051; P = 0.007). Conclusion The LGE-VTsim index, integrating quantitative LGE-CMR scar assessment with computational simulation, represents a promising exploratory parameter in identifying patients at risk of sustained VT in SHD, beyond LVEF.

Comparative Performance of Speckle Tracking Echocardiography and CMR Feature Tracking for Right Ventricular Myocardial Fibrosis in advanced heart failure.

BACKGROUND Right ventricular free wall longitudinal strain (RVFWLS) assessed by three-dimensional speckle-tracking echocardiography (3D-STE), two-dimensional (2D) STE and cardiac magnetic resonance feature tracking (CMR-FT) has been reported to correlate with the degree of right ventricular myocardial fibrosis (RVMF), but the value of 3D-STE in evaluating RVMF compared with CMR-FT has not been investigated in patients with advanced heart failure. AIMS This study aimed to determine which RVFWLS obtained by 2D-STE, 3D-STE, and CMR-FT, is the most robust noninvasive imaging marker for evaluating RVMF in patients with advanced heart failure using histopathological RVMF as the gold standard. METHODS 151 patients (118 male; mean age, 40±18 years) with advanced heart failure who underwent CMR, 2D and 3D echocardiographic examinations before heart transplantation were recruited in this study. RVFWLS was obtained from 2D-STE, 3D-STE and CMR-FT. The degree of RVMF was evaluated using late gadolinium enhancement (LGE) of CMR and Masson's staining in right ventricular myocardial samples, and patients were divided into three groups according to tertiles of histopathological RVMF. RESULTS Patients with severe RVMF had lower 3D-RVFWLS, 2D-RVFWLS and CMR-derived RVFWLS, and higher CMR-LGE compared with those with mild and moderate RVMF. RVMF was strongly correlated with CMR-derived RVFWLS (r = 0.73, p < 0.001), 3D-RVFWLS (r = 0.72, p < 0.001) and CMR-LGE (r = 0.71, p < 0.001), and moderately correlated with 2D-RVFWLS (r = 0.56, p < 0.001). The correlations of CMR-derived RVFWLS and 3D-RVFWLS with RVMF were not different from correlation of CMR-LGE with RVMF (p > 0.05). CMR-LGE, CMR-derived RVFWLS and 3D-RVFWLS had similar performance in identifying severe RVMF (AUC: 0.90 vs 0.87 vs 0.85, all p > 0.05). The model with CMR-derived RVFWLS (R2 = 0.515, p < 0.001) had a similar ability to assess RVMF as the model with 3D-RVFWLS (R2 = 0.499, p < 0.001), but better than the model with 2D-RVFWLS (R2 = 0.340, p < 0.001). CONCLUSIONS 3D-RVFWLS and CMR-derived RVFWLS are strongly correlated with RVMF in patients with advanced heart failure. 3D-STE may be a promising technique that correlates with RVMF, providing a similar accuracy as CMR-FT in assessing RVMF.

Prognostic Value of Strain Imaging Measurements in Patients with Non-ischemic Cardiomyopathy: A Scoping Review.

Nonischemic cardiomyopathy (NICM) carries significant morbidity and mortality. While left ventricular ejection fraction (LVEF) remains central to risk stratification, it may not fully capture the extent of myocardial impairment, and strain imaging can provide independent prognostic information beyond LVEF alone. Myocardial strain imaging may provide additional prognostic value, but its role in NICM remains incompletely defined. This scoping review, conducted per PRISMA-ScR guidelines, searched PubMed, Embase, and Cochrane Library from inception through October 25, 2025, to identify studies evaluating myocardial strain parameters, specifically left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain, left ventricular global radial strain, and right ventricular global longitudinal strain, in adult NICM populations using speckle-tracking echocardiography or cardiac magnetic resonance feature tracking. Data were extracted by 2 independent reviewers and synthesized descriptively. From 1356 records, 36 studies (7903 patients) were included, with follow-up ranging from 9 months to 7.8 years. LVGLS was the most frequently assessed parameter. Across 21 studies evaluating major adverse cardiovascular events, worse baseline strain values were consistently associated with increased risk (hazard ratios 1.06-2.70 per unit decrease in strain magnitude). Two studies reported significant associations with ventricular arrhythmias, and 4 showed that more favorable baseline strain predicted a higher likelihood of left ventricular reverse remodeling. Strain parameters, particularly LVGLS, remained independently associated with outcomes in 34 of 36 studies after multivariable adjustment, often providing incremental value beyond LVEF and late gadolinium enhancement. These findings support strain imaging, especially LVGLS, as an adjunct to conventional risk stratification in diverse NICM populations. Standardized, multicenter prospective studies are needed to establish its role in clinical decision-making.

Diagnostic Accuracy of Global Longitudinal Strain and Speckle-Tracking-Derived Ejection Fraction for the Detection of Reduced Left Ventricular Ejection Fraction on Cardiac Magnetic Resonance: A Secondary Diagnostic Accuracy Analysis

Left ventricular ejection fraction (LVEF) guides diagnosis and treatment across cardiovascular disease, yet cardiac magnetic resonance (CMR), the reference standard, is frequently unavailable in middle-income settings. In this study we determined optimal cut-off values of global longitudinal strain (GLS) and speckle-tracking-derived LVEF for detecting CMR-defined reduced LVEF, compared their diagnostic accuracy, and reported sensitivity, specificity, likelihood ratios, and predictive values. We believe the work is a good fit for PLOS ONE as a methodologically rigorous, hypothesis-generating diagnostic-accuracy study of potential value for settings with limited access to advanced imaging. It is reported following the STARD 2015 guideline (included as Supporting Information) and includes a QUADAS-2 assessment and internal validation of the derived thresholds. In the interest of full transparency, we wish to disclose that this manuscript is a secondary analysis of a patient cohort previously reported by our group in a concordance study among Simpson-derived LVEF, GLS, and CMR-derived LVEF (Herrera-Escandon A, et al. Arq Bras Cardiol Imagem Cardiovasc. 2026;39(2):e20250102). The present study addresses a distinct research question, namely the diagnostic accuracy and optimal cut-off of these echocardiographic markers against a dichotomized CMR reference standard, that was not examined in that report, and it is cited and discussed accordingly in the manuscript. No figures, tables, or text have been reproduced from the prior publication. We make this overlap explicit in accordance with ICMJE recommendations on overlapping publications and are happy to provide the prior article to the editorial office.