# Strain Analysis from Transverse CMR Cine Imaging in Congenital Heart Disease: Feasibility, Reproducibility, and Comparison to Global Longitudinal Strain

## TL;DR

This study explores a new way to measure heart muscle strain using transverse CMR images, finding it reliable and potentially useful for patients with congenital heart disease.

## Contribution

The study introduces transverse strain (TrS) as a novel, reproducible method for strain assessment in congenital heart disease patients.

## Key findings

- TrS showed high intra- and interobserver reproducibility in patients with congenital heart disease.
- TrS had strong agreement with GLS in Fontan patients and ToF patients' right ventricles.
- TrS showed a positive bias compared to GLS in left ventricles of ToF patients and healthy controls.

## Abstract

Background: Global longitudinal strain (GLS), derived from long-axis cine images (LAX), is a sensitive marker for myocardial dysfunction and a strong predictor for clinical events and future ventricular deterioration. In patients with complex congenital heart disease (CHD) transverse-oriented cine imaging is part of the standard cardiac magnetic resonance (CMR) protocol. We aimed to study the feasibility and reproducibility of strain measurements derived from transverse-oriented cine images (Transverse Strain (TrS)) and compare them with standard GLS. Methods: We retrospectively analyzed CMR cine images from 40 patients (n = 20 Fontan, n = 20 Tetralogy of Fallot (ToF)) and 10 healthy controls. Strain analysis was performed in every subject using both the conventional GLS and the TrS approach. Results: TrS showed high intra- and interobserver reproducibility in patients with CHD (intraclass correlation coefficient (ICC) > 0.75, p < 0.05). Intermethod agreement between TrS and GLS was strong in Fontan patients and in the right ventricle (RV) of ToF patients (ICC > 0.75) but showed a positive bias for TrS in the left ventricle (LV) of ToF patients (mean difference = 5.03) and in both ventricles of healthy controls (mean difference LV = 5.36, RV = 4.01). Conclusions: TrS is feasible and reproducible and may offer a new methodological approach for strain assessment, especially in CHD patients with univentricular physiology and ToF patients. Further studies are needed to validate this new approach and perform correlations to clinical outcomes.