الفهرس 
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Abstract
Cardiovascular magnetic resonance (CMR) imaging has a number of advantages over other imaging modalities, including high resolution imaging without limitation by acoustic window, low risk to the patient, and reproducible measurement of left-sided volumes and ejection fraction.
FT-CMR is a simple, fast method for measurement of myocardial deformation that offers promise for quantifying function of both ventricles and atria. FT-CMR is better than STE because it provides an excellent contrast between blood pool and the myocardium and produces good image quality more reliably without limitation by acoustic window. This is particularly important in congenital heart disease patients.
The aims of the following study are, firstly to determine whether 3D feature-tracking offers superior reproducibility compared to 2D methods and to define the reference ranges for 3D FT-CMR for the LV, secondly, to define reference ranges for the RV and RA peak longitudinal strain and strain rate by 2D FT-CMR and to determine reproducibility of analysis of deformation of the RV and RA using FT-CMR and lastly to compare myocardial deformation in adult patients with unrepaired EA and control subjects and to investigate the relationship with exercise capacity as a known predictor of outcome in these patients measured using cardiopulmonary exercise testing (CPEX).
The study was conducted at Queen Elizabeth Hospital Birmingham, UK between 1st of September 2016 and 1st of January 2018.
Thirty-six unrepaired Ebetsin patients were retrospectively identified from the hospital database. The scans of 36 age and sex matched healthy controls were analyzed. Feature tacking CMR was performed for the RV, LV & functional RA.
In order to assess the reference ranges for LV, RV & RA deformation, the scans of a cohort of 100 normal healthy subjects -in a pre-determined, stratified fashion, to include 10 men and 10 women in each of 5 age deciles from 20 to 70 years- were analyzed. .
Results
FW-GLS (-24.21±3.59) was significantly higher than FW+S GLS (-21.87±3.24) (p<0.001). There were no gender differences in strain or strain rate. For both techniques, there were no clear relationship between strain or strain rates and increasing age on linear regression analysis.
Intra- and inter-observer reproducibility for RV and RA GLS were consistently high (ICC range 0.80-0.92).
Reproducibility biases were significantly lower for almost all strain and strain rates when derived from 3D feature tracking models. Similarly, 3D feature tracking had superior ICC compared to 2D models for the majority of peak strain and strain rate parameters.
All the strain parameters except the peak global radial strain were significantly impaired in Ebstein’s patients compared to their matched controls. RA peak strain correlated with percent predicted VO2 peak (r=-0.472, p=0.017), peak VO2 (r=-0.431, p=0.028) and VE/VCO2 slope (r= 0.414, p=0.036 respectively). RV S velocity showed significant correlated with peak VO2 (r=0.578, p= 0.049). EF was not correlated with CPEX parameters.