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Afterload quantitation for evaluation of myocardial strain


Systolic myocardial strain is load dependent, but the CMR literature largely disregards effects of myocardial afterload on strain and strain rate. This may reflect well known limitations of conventional myocardial afterload assessment using wall stress analyses, which are based on erroneous assumptions about left ventricular(LV) geometry and/or myocardial material properties. Therefore, we compared the utility of a nongeometric afterload index(NGI) derived from LV pressure(P) volume(V) and mass, which requires no assumptions about material properties, to that of conventional noninvasive end-systolic circumferential stress(CWS) as determinants of CMR LV circumferential strain(CST), ejection fraction(EF) and strain rate(SR) in normals(NL) and patients with nonischemic dilated cardiomyopathy(CM).


We obtained breath-hold volumetric short-axis SSFP cines, cuff systolic P, systolic duration, LVV, M and EF, feature-tracking global CST(TomTec Imaging Systems) and mean SR in NLs(n = 39, 46%female, age 54.6(sd14.6)yrs) and CM (n = 35, 23% female, age 50.8(sd15.0) yrs, EF 27.2%(sd10.8%). CWS was calculated using Mirsky's formula(Biophys. J.1969) while NGI was determined as end-systolic PV/M.


EF, CST and CSR were markedly reduced in CM compared to NL(EF 27.2%(sd10.8)vs 58.4%(4.6), (-53%)p < 0.0001; CST -10.7%(5.3) vs -23.9%(4.3), (-55%), p < 0.0001);(CSR -32.1%/s(14.8) vs -65.7(14.9) p < 0.0001). But CWS was also markedly elevated in CM versus NL(CWS 307.6(9.2) vs 176.2(42.1)x 103 dyn/cm2,(+75%), p < 0.0001). Thus afterload excess due to adverse LV remodeling, may account for most EF, strain and strain rate reduction in CM. However, PV/M was more markedly increased than CWS, (162.6(sd48.9) vs 84.4(18.4)(+93%) p < 0.0001) and correlated more closely and significantly with EF, CST and CSR than CWS in the expected inverse relationship in both NL and CM subgroups(Table 1). In stepwise regressions only PV/M was a significant correlate of EF, strain and strain rate in both subgroups.

Table 1 Afterload Indices Versus EF, Strain and Strain Rate


Afterload excess due to adverse LV remodeling is an important determinant of reduced myocardial and LV chamber function in CM, making a major contribution to reductions in EF, CST and SR, but PV/M, a simple, nongeometric afterload index, is superior to conventional wall stress calculation as a quantitative afterload index.


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Correspondence to Nathaniel Reichek.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Reichek, N., Janosevic, D., Jayam, M. et al. Afterload quantitation for evaluation of myocardial strain. J Cardiovasc Magn Reson 16, P320 (2014).

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  • Ejection Fraction
  • Myocardial Strain
  • Left Ventricular Chamber
  • Adverse Left Ventricular Remodel
  • SSFP Cine