| Summary: | <jats:sec><jats:title>Purpose</jats:title><jats:p>To evaluate if a fully-automatic deep learning method for myocardial strain analysis based on magnetic resonance imaging (MRI) cine images can detect asymptomatic dysfunction in young adults with cardiac risk factors.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>An automated workflow termed DeepStrain was implemented using two U-Net models for segmentation and motion tracking. DeepStrain was trained and tested using short-axis cine-MRI images from healthy subjects and patients with cardiac disease. Subsequently, subjects aged 18–45 years were prospectively recruited and classified among age- and gender-matched groups: risk factor group (RFG) 1 including overweight without hypertension or type 2 diabetes; RFG2 including hypertension without type 2 diabetes, regardless of overweight; RFG3 including type 2 diabetes, regardless of overweight or hypertension. Subjects underwent cardiac short-axis cine-MRI image acquisition. Differences in DeepStrain-based left ventricular global circumferential and radial strain and strain rate among groups were evaluated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The cohort consisted of 119 participants: 30 controls, 39 in RFG1, 30 in RFG2, and 20 in RFG3. Despite comparable (&gt;0.05) left-ventricular mass, volumes, and ejection fraction, all groups (RFG1, RFG2, RFG3) showed signs of asymptomatic left ventricular diastolic and systolic dysfunction, evidenced by lower circumferential early-diastolic strain rate (&lt;0.05, &lt;0.001, &lt;0.01), and lower septal circumferential end-systolic strain (&lt;0.001, &lt;0.05, &lt;0.001) compared with controls. Multivariate linear regression showed that body surface area correlated negatively with all strain measures (&lt;0.01), and mean arterial pressure correlated negatively with early-diastolic strain rate (&lt;0.01).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>DeepStrain fully-automatically provided evidence of asymptomatic left ventricular diastolic and systolic dysfunction in asymptomatic young adults with overweight, hypertension, and type 2 diabetes risk factors.</jats:p></jats:sec>
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