Correlation of CT-based regional cardiac function (SQUEEZ) with myocardial strain calculated from tagged MRI: an experimental study
- 292 Downloads
The objective of this study was to investigate the correlation between local myocardial function estimates from CT and myocardial strain from tagged MRI in the same heart. Accurate detection of regional myocardial dysfunction can be an important finding in the diagnosis of functionally significant coronary artery disease. Tagged MRI is currently a reference standard for noninvasive regional myocardial function analysis; however, it has practical drawbacks. We have developed a CT imaging protocol and automated image analysis algorithm for estimating regional cardiac function from a few heartbeats. This method tracks the motion of the left ventricular (LV) endocardial surface to produce local function maps: we call the method Stretch Quantification of Endocardial Engraved Zones (SQUEEZ). Myocardial infarction was created by ligation of the left anterior descending coronary artery for 2 h followed by reperfusion in canine models. Tagged and cine MRI scans were performed during the reperfusion phase and first-pass contrast enhanced CT scans were acquired. The average delay between the CT and MRI scans was <1 h. Circumferential myocardial strain (Ecc) was calculated from the tagged MRI data. The agreement between peak systolic Ecc and SQUEEZ was investigated in 162 segments in the 9 hearts. Linear regression and Bland–Altman analysis was used to assess the correlation between the two metrics of local LV function. The results show good agreement between SQUEEZ and Ecc: (r = 0.71, slope = 0.78, p < 0.001). Furthermore, Bland–Altman showed a small bias of −0.02 with 95 % confidence interval of 0.1, and standard deviation of 0.05 representing ~6.5 % of the dynamic range of LV function. The good agreement between the estimates of local myocardial function obtained from CT SQUEEZ and tagged MRI provides encouragement to investigate the use of SQUEEZ for measuring regional cardiac function at a low clinical dose in humans.
KeywordsMyocardial function Tagged MRI Contractility CT SQUEEZ
This research was supported in part by the Maryland Innovation Initiative grant (115127) titled “Diagnostic Method for Rapid Detection of Significant Coronary Heart Disease”.
Compliance with ethical standards
Conflict of interest
Drs. Pourmorteza and McVeigh are inventors on a pending patent for SQUEEZ (WO Patent 2013056082).
All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.
- 1.Seneviratne SK, Truong QA, Bamberg F, Rogers IS, Shapiro MD, Schlett CL, Chae CU, Cury R, Abbara S, Brady TJ, Nagurney JT, Hoffmann U (2010) Incremental diagnostic value of regional left ventricular function over coronary assessment by cardiac computed tomography for the detection of acute coronary syndrome in patients with acute chest pain: from the ROMICAT trial. Circ Cardiovasc Imaging 3:375–383CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, Scherer M, Bellinger R, Martin A, Benton R, Delago A, Min JK (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coro. J Am Coll Cardiol 52:1724–1732CrossRefPubMedGoogle Scholar
- 4.Min JK, Leipsic J, Pencina MJ, Berman DS, Koo BK, van Mieghem C, Erglis A, Lin FY, Dunning AM, Apruzzese P, Budoff MJ, Cole JH, Jaffer FA, Leon MB, Malpeso J, Mancini GB, Park SJ, Schwartz RS, Shaw LJ, Mauri L (2012) Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA 308:1237–1245CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Al-Mallah MH, Qureshi W, Lin FY, Achenbach S, Berman DS, Budoff MJ, Callister TQ, Chang HJ, Cademartiri F, Chinnaiyan K, Chow BJ, Cheng VY, Delago A, Gomez M, Hadamitzky M, Hausleiter J, Kaufmann PA, Leipsic J, Maffei E, Raff G, Shaw LJ, Villines TC, Cury RC, Feuchtner G, Plank F, Kim YJ, Dunning AM, Min JK (2014) Does coronary CT angiography improve risk stratification over coronary calcium scoring in symptomatic patients with suspected coronary artery disease? Results from the prospective multicenter international CONFIRM registry. Eur Heart J Cardiovasc Imaging 15(3):267–274Google Scholar
- 6.Douglas PS, Hoffmann U, Patel MR, Mark DB, Al-Khalidi HR, Cavanaugh B, Cole J, Dolor RJ, Fordyce CB, Huang M, Khan MA, Kosinski AS, Krucoff MW, Malhotra V, Picard MH, Udelson JE, Velazquez EJ, Yow E, Cooper LS, Lee KL (2015) Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med 372(14):1291–1300Google Scholar
- 8.Pourmorteza A, Schuleri KH, Herzka DA, Lardo AC, McVeigh ER (2012) Regional cardiac function assessment in 4D CT: comparison between SQUEEZ and ejection fraction, Engineering in Medicine and Biology Society (EMBC). In: Annual international conference of the IEEE, 2012Google Scholar
- 15.Nakazato R, Tamarappoo BK, Smith TW, Cheng VY, Dey D, Shmilovich H, Gutstein A, Gurudevan S, Hayes SW, Thomson LEJ, Friedman JD, Berman DS (2011) Assessment of left ventricular regional wall motion and ejection fraction with low-radiation dose helical dual-source CT: comparison to two-dimensional echocardiography. J Cardiovasc Comput Tomogr 5:149–157CrossRefPubMedGoogle Scholar
- 16.Tee MW, Won S, Raman FS, Yi C, Vigneault DM, Davies-Venn C, Liu S, Lardo AC, Lima JAC, Noble JA (2015) Regional strain analysis with multidetector CT in a swine cardiomyopathy model: relationship to cardiac MR tagging and myocardial fibrosis. Radiology 142339Google Scholar