Segment length in cine (SLICE) strain analysis: a practical approach to estimate potential benefit from cardiac resynchronization therapy

A. Zweerink, R. Nijveldt, N.J. Braams, A.H. Maass, K. Vernooy, F.J. de Lange, M. Meine, B. Geelhoed, M. Rienstra, I.C. van Gelder, M.A. Vos, A.C. van Rossum, C.P. Allaart*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Segment length in cine (SLICE) strain analysis on standard cardiovascular magnetic resonance (CMR) cine images was recently validated against gold standard myocardial tagging. The present study aims to explore predictive value of SLICE for cardiac resynchronization therapy (CRT) response.Methods and results: Fifty-seven patients with heart failure and left bundle branch block (LBBB) were prospectively enrolled in this multi-center study and underwent CMR examination before CRT implantation. Circumferential strains of the septal and lateral wall were measured by SLICE on short-axis cine images. In addition, timing and strain pattern parameters were assessed. After twelve months, CRT response was quantified by the echocardiographic change in left ventricular (LV) end-systolic volume (LVESV). In contrast to timing parameters, strain pattern parameters being systolic rebound stretch of the septum (SRSsep), systolic stretch index (SSIsep-lat), and internal stretch factor (ISFsep-lat) all correlated significantly with LVESV change (R - 0.56; R - 0.53; and R - 0.58, respectively). Of all strain parameters, end-systolic septal strain (ESSsep) showed strongest correlation with LVESV change (R - 0.63). Multivariable analysis showed ESSsep to be independently related to LVESV change together with age and QRS(AREA).Conclusion: The practicable SLICE strain technique may help the clinician to estimate potential benefit from CRT by analyzing standard CMR cine images without the need for commercial software. Of all strain parameters, end-systolic septal strain (ESSsep) demonstrates the strongest correlation with reverse remodeling after CRT. This parameter may be of special interest in patients with non-strict LBBB morphology for whom CRT benefit is doubted.
Original languageEnglish
Article number4
Number of pages12
JournalJournal of Cardiovascular Magnetic Resonance
Issue number1
Publication statusPublished - 11 Jan 2021


  • candidates
  • cardiac resynchronization therapy (crt)
  • cardiovascular magnetic resonance (cmr)
  • contraction
  • dyssynchrony
  • improvement
  • magnetic-resonance
  • myocardial scar
  • myocardial strain
  • predictors
  • segment length in cine (slice)
  • super-response
  • Myocardial strain
  • Segment length in cine (SLICE)
  • Cardiovascular magnetic resonance (CMR)
  • Cardiac resynchronization therapy (CRT)

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