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The evaluation of coronary microvascular obstruction in patients with STEMI by cardiac magnetic resonance T2-STIR image and layer-specific analysis of 2-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography

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Abstract

This study was designed to assess coronary microvascular obstruction (MVO) in patients with acute ST-segment elevation myocardial infarction (STEMI) by cardiac magnetic resonance T2-weighted short tau inversion recovery (T2-STIR) image and layer-specific analysis of 2-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography (LDDSE-LS2D-STE). 32 patients were enrolled to perform cardiac magnetic resonance and echocardiography 5–7 days after primary percutaneous coronary intervention. Infarcted myocardium was categorized into MVO+ group and MVO− group by late gadolinium enhancement as gold standard. At T2-weighted image, the area of hyper-intense region and hypo-intense core inside were marked as A1, A2 and A2/A1 > 0 represented MVO. Strain parameters were composed of longitudinal strain (LS), circumferential strain and radial strain at rest and dobutamine stress. There were 94 MVO+ segments, 136 MVO− segments according to gold standard. 96 segments had hypo-intense core at T2-STIR image. The sensitivity and specificity of T2-STIR in detecting MVO were 91.49 and 92.65%. Endocardial LS was superior to other parameters, and stress endocardial LS was higher than that of resting endocardial LS (sensitivity: 77.11% vs 72.29%, specificity: 93.28% vs 83.19%, AUC: 0.87 vs 0.82, P < 0.05). The combination of T2-STIR and stress endocardial LS in parallel test could improve sensitivity significantly (98.05% vs 91.49%). T2-STIR has higher diagnostic value in detecting MVO with some limitations. However, LDDSE-LS2D-STE with cost-effective and handling may be a good alternative to T2-STIR. It provides additional and reliable diagnostic tools to identify MVO in STEMI patients after reperfusion.

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Acknowledgements

The authors thank the staff of the Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University for their selfless and valuable assistance.

Funding

This work was supported by Jiangsu Provincial Science and Technology Department Social Development Fund [BE2019639], Jiangsu Provincial Administration of Traditional Chinese Medicine [YB201988] and Jiangsu Provincial Health Commission Project Fund [M2020015].

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Author notes

  1. Zhihao Lu and Tao Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China

    Zhihao Lu, Tao Liu, Chaofan Wang, Haochen Xuan, Yan Yan, Junhong Chen, Yuan Lu, Dongye Li & Tongda Xu

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  1. Zhihao Lu
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  2. Tao Liu
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  3. Chaofan Wang
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  7. Yuan Lu
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Contributions

ZL: Formal analysis, Investigation, Writing—Original Draft; TL: Methodology, Data Curation; CW: Methodology, Data Curation; HX: Software, Validation; YY: Resources; JC: Visualization; YL: Resources; DL: Conceptualization, Supervision, Project administration; TX: Conceptualization, Writing—Review & Editing, Funding acquisition.

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Correspondence to Dongye Li or Tongda Xu.

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Lu, Z., Liu, T., Wang, C. et al. The evaluation of coronary microvascular obstruction in patients with STEMI by cardiac magnetic resonance T2-STIR image and layer-specific analysis of 2-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography. Heart Vessels 38, 40–48 (2023). https://doi.org/10.1007/s00380-022-02131-x

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