Three-dimensional speckle-tracking echocardiography and cardiac magnetic resonance feature tracking for assessment of left ventricular myocardial fibrosis in patients with end-stage heart failure

Background Three-dimensional (3D) speckle-tracking echocardiography (STE) and cardiac magnetic resonance (CMR) feature tracking (FT) have been reported to correlate with the extent of left ventricular myocardial fibrosis (LVMF), but the value of 3D-STE in predicting LVMF compared with CMR-FT has not been investigated in patients with end-stage heart failure (HF). Materials and methods A total of 155 patients who underwent CMR, two-dimensional (2D) and 3D echocardiographic examinations before heart transplantation were enrolled. Left ventricular global radial strain (GRS), global circumferential strain (GCS) and global longitudinal strain (GLS) were obtained from CMR-FT, 3D-STE and 2D-STE. The degree of LVMF was quantified using Masson’s trichrome staining in left ventricular myocardial samples from the explanted hearts, and patients were divided into three groups according to tertiles of histologic LVMF. Results 3D-GLS, 2D-GLS, CMR-GLS and CMR-GCS were lower in patients with severe LVMF than in those with mild and moderate LVMF. LVMF was strongly correlated with CMR-GLS and 3D-GLS (r = 0.74, 0.73, respectively; both P < 0.001), moderately correlated with 2D-GLS (r = 0.63, P < 0.001). CMR-GLS and 3D-GLS demonstrated similar diagnostic performance in identifying severe LVMF (area under the curve: 0.88 vs. 0.86, P > 0.05). The model with CMR-GLS (R 2 = 0.550, P < 0.001) had a similar predictive value for the degree of LVMF as the model with 3D-GLS (R 2 = 0.528, P < 0.001), and outperformed the model with 2D-GLS (R 2 = 0.383, P < 0.001). Conclusions Both CMR-GLS and 3D-GLS are strongly correlated with LVMF, and are promising non-invasive imaging parameters for the assessment of LVMF in patients with end-stage HF.