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Background: Patients with repaired tetralogy of Fallot (rTOF) continue to face a heightened risk of deteriorating cardiac function, and quantitative techniques of cardiac MRI‐derived cardiac structure and function provide an opportunity to explore the causes and mechanisms of cardiac deterioration. Purpose: To explore right–left ventricular interdependence in rTOF patients before and after the onset of right ventricular (RV) heart failure. Study Type: Retrospective. Population: One hundred eighteen rTOF patients (21.85 [16.74, 29.20] years, 58 females) and 34 controls (23.5 [21, 26.5] years, 17 females) that underwent cardiac MRI were analyzed, with rTOF patients being further subdivided into those with preserved RV function (N = 54) and those that experienced RV heart failure (N = 64). Field Strength/Sequence: 3.0 T/balanced steady‐state free precession sequence. Assessment: RV, left ventricular (LV), and septal strain; RV and LV volume. Statistical Tests: Chi‐squared tests or Fisher's exact test, One‐way ANOVAs with Bonferroni's post hoc test, Pearson/Spearman correlation, and multivariate backward linear regression analysis. A two‐tailed P < 0.05 was deemed as the significance threshold. Results: The MRI‐derived RV, LV, and septal strain decreased sequentially in controls, patients with preserved RV function, and patients with RV heart failure, with a good intra‐observer (0.909–0.964) and inter‐observer (0.879–0.937) agreement. Correlations between LV and RV strain were found to change sequentially with RV function and were the closest in rTOF patients with RV heart failure (r = −0.270 to 0.506). Correlations between RV volume and septal strain was variable in controls (r = 0.483 to −0.604), patients with preserved RV function (r = −0.034 to −0.295), and patients with RV heart failure (r = −0.026 to 0.500). Multivariate analyses revealed that the RV longitudinal strain was independently correlated with LV strain in three directions in rTOF patients with RV heart failure (Radial −0.70 [−1.33, −0.06]; Circumferential 0.44 [0.17, 0.72]; Longitudinal 0.54 [0.26, 0.81]). Data Conclusion: In rTOF patients, the coupling between RV volume and septal strain was broken during RV function compensation, and the adverse effect of RV on LV deformation was highest in patients with RV heart failure. Evidence Level: 4 Technical Efficacy: Stage 5 [ABSTRACT FROM AUTHOR]

Background: Pulmonary hypertension (PH) results in right ventricular (RV) dysfunction, subsequently leading to left ventricular (LV) impairment. The mechanism underlying ventricular interdependence is largely uninvestigated. Purpose: To explore the biventricular dysfunction and the ventricular interdependence in PH patients. Study Type: Retrospective. Population: One hundred and seven PH patients (mean pulmonary artery pressure >20 mmHg) and 72 age‐ and sex‐matched controls with cardiac magnetic resonance imaging (MRI) studies. Field Strength/Sequence: 3.0 T/balanced steady‐state free precession sequence. Assessment: LV and RV ejection fractions (EF) and RV and LV radial, circumferential, and longitudinal strains were assessed using commercial software. Strains were compared between controls, PH patients with preserved RVEF (RVEF ≥40%, N = 48), and PH patients with reduced RVEF (RVEF <40%, N = 59). Statistical Tests: Chi‐squared tests or Fisher's exact test, t tests or Mann–Whitney U test, one‐way ANOVA with Bonferroni's post hoc correction or Kruskal–Wallis test, Pearson or Spearman correlation, and multivariable linear regression analysis. A two‐tailed P < 0.05 was deemed statistically significant. Results: RV strain decreased sequentially from controls, through PH with preserved RVEF, to PH with reduced RVEF. PH patients with reduced RVEF had significantly lower LV strain, especially septal strain, and LV peak diastolic strain rate compared with both controls and PH patients with preserved RVEF. Multivariable analyses showed that RVEF was independently correlated with LV strain; furthermore, independent of RVEF, RV strain was significantly correlated with LV strain (LVGRS: β = 0.416; LVGCS: β = −0.371; LVGLS: β = 0.283). Data Conclusion: Subclinical impairment of RV function was found in PH with preserved RVEF. LV strain was impaired when RV was dysfunctional, which was associated with worsening RV strain. Therefore, while focusing on improving RV function, LV dysfunction in PH patients should also be monitored and treated early in order to slow the progression of the disease. Level of Evidence: 3 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Background: Hypertension (HTN) is highly prevalent in non‐ischemic dilated cardiomyopathy (NIDCM) patients, but little is known about its impact on left ventricular (LV) function and remodeling. Purpose: To evaluate the effect of hypertension on LV function and remodeling in NIDCM patients. Study Type: Retrospective. Population: Two‐hundred and twelve NIDCM (HTN−) patients, 91 NIDCM (HTN+) patients, and 74 normal controls. Field Strength/Sequence: 3.0 T/bSSFP and phase‐sensitive inversion recovery sequence. Assessment: The LV geometry, myocardial strain, remodeling index (calculated as LVM/LVEDV), and LGE were measured and compared between groups. Determinants of LV strain and remodeling in NIDCM were investigated. Statistical Tests: Student's t‐test, Mann–Whitney U test, one‐way analysis of variance, Kruskal–Wallis test, univariable and multivariable linear regression. A P value <0.05 was considered statistically significant. Results: Compared with normal controls, NIDCM patients had significantly higher LVEDV and significantly impaired LV strains, including LV global peak strain (PS) and peak systolic and diastolic strain rates in the radial, circumferential, and longitudinal directions. The NIDCM (HTN+) group had significantly decreased LV global longitudinal PS and peak diastolic strain rate (PDSR), and significantly increased LV mass index and remodeling index compared to the NIDCM (HTN−) group, despite there being no significant difference in ejection fraction (P = 0.241). The prevalence of LV LGE was significantly higher in the NIDCM (HTN+) group than in the NIDCM (HTN−) group. In multivariable regression models adjusted for potential confounders, hypertension was independently associated with LV global longitudinal PS and PDSR. Male sex, resting heart rate, and log(NT‐proBNP) level were independent determinants of LV strains. Moreover, male sex, systolic and diastolic blood pressure, and presence of LGE were independent determinants of LV remodeling index. Data Conclusion: These findings suggest that coexistence of hypertension may further exacerbate the reduction in LV global strain and the aggravation of LV remodeling in NIDCM patients. Level of Evidence: 3 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) and obesity often coexist and together contribute to left atrial (LA) functional abnormalities. However, little is known about the impact of body mass index (BMI) on LA strains measured using cardiac magnetic resonance feature tracking (MR‐FT). Purpose: To investigate the additive effect of BMI on LA functional remodeling using MR‐FT as well as to explore abnormal atrioventricular interaction in T2DM patients. Study Type: Retrospective. Population: One hundred and fifty‐nine T2DM patients (53, 34, and 72 normal‐weight, overweight, and obese individuals) and 105 non‐diabetic controls (46, 32, and 27 normal‐weight, overweight, and obese individuals). Field Strength/Sequence: 3.0 T/balanced steady‐state free precession. Assessment: LA reservoir strain (εs), conduit strain (εe), and active strain (εa) and their corresponding strain rates (SRs, SRe, SRa) were measured together with left ventricular (LV) radial, circumferential, and longitudinal peak strain, peak systolic strain rate, and peak diastolic strain rate. Statistical Tests: Student's t‐test or Mann–Whitney U test, one‐way ANOVA, univariate and multivariate linear regression. A P value <0.05 was considered statistically significant. Results: Compared to controls in the same BMI category, T2DM patients had significantly decreased reservoir and conduit function, while pump function was not significantly different (εa and SRa: P = 0.757 and 0.583 for normal‐weight, P = 0.171 and 0.426 for overweight, P = 0.067 and 0.330 for obese). LA strains were significantly correlated with BMI (r = −0.346 for εs, −0.345 for εe) in T2DM patients. Multivariable linear regression analysis indicated that BMI was independently associated with LA εs and εe, LV global longitudinal strain was independently associated with LA εs and εa, and LV circumferential peak diastolic strain rate was independently associated with LA εe. Data Conclusion: These findings suggest that the coexistence of increased body weight and T2DM patients can exacerbate the impairment of LA strains and indicate abnormal atrioventricular interactions. Level of Evidence: 3 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Left ventricular (LV) myocardial strain impairment has been demonstrated in hypertension despite normal LV ejection fraction (LVEF); however, limited data exist on any difference in results between genders. The aim of this study was to investigate the impact of gender on LV deformation in patients with essential hypertension. This was a cross‐sectional study, in which 94 patients (47 men and 47 women) with essential hypertension and 62 age‐ and gender‐matched controls (31 men and 31 women) were enrolled. A 3.0 T/two‐dimensional balanced steady‐state free precession cine, late gadolinium enhancement was used. The LV endocardial and epicardial contours were drawn by radiologists, then LV volumes, mass, function, and myocardial strain, including peak global radial (GRS), circumferential (GCS), and longitudinal strain (GLS) were automatically calculated. Chi‐square test, Student's t‐test, general linear model analysis, univariate linear regression analysis, stepwise multivariate linear regression analysis, and intraclass correlation coefficient analysis were performed. Women had significantly higher magnitudes of LV GRS, GCS, and GLS than men in both patients and controls (all p < 0.05). In the overall patients, LV GLS was significantly reduced compared with controls (p < 0.05), while GRS and GCS were preserved (p = 0.092 and 0.27, respectively). Compared with their counterpart controls, LV GRS, GCS, and GLS (all p < 0.05) were significantly reduced in hypertensive men, while only GLS (p < 0.05) was reduced in hypertensive women. Male gender and its interaction with hypertension were associated with higher LV mass and volume, decreased LV GRS, GCS, and GLS compared with hypertensive women. Multivariate analyses revealed that gender and LVEF were independently associated with GRS, GCS, and GLS (all p < 0.001) in hypertension. LV deformation is significantly reduced in hypertension, and gender may influence the response of LV deformation to hypertension, with men suffering more pronounced subclinical myocardial dysfunction. Level of Evidence: 3 Technical Efficacy Stage: 3 [ABSTRACT FROM AUTHOR]