CMR may provide an emerging alternative method of quantified dyssynchrony because it is considered to be the gold standard imaging modality for assessment of myocardial strain [
13,
14,
27‐
29]. CMR allows for high spatial resolution with excellent signal-to-noise ratio and highly reproducible wall motion tracking. Assessment of global and regional myocardial deformation has been feasible with the use of myocardial tagging. In short, it consists of tagging the myocardium with temporary physical markers that can be tracked through the cardiac cycle. This can be done in the image domain, such as saturation, spatial modulation of magnetization SPAMM and complementary SPAMM (CSPAMM) or in the K-space/spatial-frequency domain, such as harmonic phase (HARP), displacement encoding with stimulated echoes (DENSE) [
15]. The specific technical details of these sequences have been described elsewhere [
15]. Previous investigators have use boundary tracking CMR approaches to assess cardiac dyssynchrony [
30,
31]. However, CMR measurements of myocardial strain and dyssynchrony has been mostly seen as an important research tool, and have not gained widespread clinical use because they are considered by some to be a cumbersome and complicated image acquisition and post processing analysis. Technological advances in parallel processing, stronger fields gradients and better receiver coil units have allowed improvements in both the spatial and temporal resolution have allowed for the quantification of dyssynchrony without the need of tagged images, using conventional CMR SSFP images [
32‐
34]. Chalil et al, have recently shown that tissue-synchronization imaging derived from SSFP cine images, allowed mechanical dyssynchrony assessment identifying patients with increased risk for major cardiovascular event [
32,
33]. In this study, we assessed the feasibility of a novel semi-automated feature tracking CMR software (FT-CMR) approach using SSFP imaging. FT-CMR allowed easy quantification of radial dyssynchrony which was highly correlated with dyssynchrony measures by speckle tracking echocardiography (r = 0.93, p < 0.0001). In addition, FT-CMR was able to identify patients with narrow and wide QRS with same precision as conventional speckle-tracking echocardiography, albeit with lower variability of only 4 ± 4% for intra-observer and 5 ± 6% for inter-observer when comparing speckle tracking echocardiography, which had an intra- and inter-observer variability averaging from 8 to 9% and as described previously [
19,
21]. Lastly, attesting to the superior image quality of CMR, radial dyssynchrony analysis was suitable in all the 72 patients (100%) using quantitative FT-CMR vs. 67 patients (93%) using speckle tracking echocardiography analysis (p = 0.05).