Magnetic resonance-derived circumferential strain provides a superior and incremental assessment of improvement in contractile function in patients early after ST-segment elevation myocardial infarction

Abstract

Background

We evaluate whether circumferential strain derived from grid-tagged CMR is a better method for assessing improvement in segmental contractile function after STEMI compared to late gadolinium enhancement (LGE).

Methods

STEMI patients post primary PCI underwent baseline CMR (day 3) and follow-up (day 90). Cine, grid-tagged and LGE images were acquired. Baseline LGE infarct hyperenhancement was categorised as ≤25 %, 26-50 %, 51-75 % and >75 % hyperenhancement. The segmental baseline circumferential strain (CS) and circumferential strain rate (CSR) were calculated from grid-tagged images. Segments demonstrating an improvement in wall motion of ≥1 grade compared to baseline were regarded as having improved segmental contractile-function.

Results

Forty-five patients (aged 58 ± 12 years) and 179 infarct segments were analysed. A baseline CS cutoff of -5 % had sensitivity of 89 % and specificity of 70 % for detection of improvement in segmental-contractile-function. On receiver-operating characteristic analysis for predicting improvement in contractile function, AUC for baseline CS (0.82) compared favourably to LGE hyperenhancement (0.68), MVO (0.67) and baseline-CSR (0.74). On comparison of AUCs, baseline CS was superior to LGE hyperenhancement and MVO in predicting improvement in contractile function (P < 0.001). On multivariate-analysis, baseline CS was the independent predictor of improvement in segmental contractile function (P < 0.001).

Conclusion

Grid-tagged CMR-derived baseline CS is a superior predictor of improvement in segmental contractile function, providing incremental value when added to LGE hyperenhancement and MVO following STEMI.

Key points

Baseline CS predicts contractile function recovery better than LGE and MVO following STEMI

Baseline CS predicts contractile function recovery better than baseline CSR following STEMI

Baseline CS provides incremental value to LGE and MVO following STEMI

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Abbreviations

LGE:

Late gadolinium enhancement

CMR:

Cardiac magnetic resonance imaging

STEMI:

ST segment elevation myocardial infarction

LV:

Left ventricular

PPCI:

Primary percutaneous coronary intervention

PCI:

Percutaneous coronary intervention

MVO:

Microvascular obstruction

ROC:

Receiver-operating characteristic

AUC:

Area under the curve

IDI:

Integrated discrimination improvement

CS:

Circumferential systolic strain

CSR:

Circumferential systolic strain rate

FOV:

Field of view

TR:

Repetition time

TE:

Echo time

EDV:

End diastolic volume

ESV:

End systolic volume

HARP:

Harmonic phase

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Acknowledgments

DW is supported by a NHMRC and NHF Post Graduate Scholarship. DL is supported by a NHMRC and NHF Post-Doctoral Fellowship. JDR is supported by an International Postgraduate Research Scholarship and Australian Postgraduate Award (University of Adelaide). PJP is supported by an NHMRC Post-Doctoral Biomedical Research Scholarship. MIW is supported by an SA Health Practitioner Fellowship.

The scientific guarantor of this publication is Dr Dennis TL Wong. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (Dr Darryl Leong) has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some of the study subjects or cohorts have been previously reported in Wong DT, Weightman MJ, Baumert M, et al. (2012) Electro-mechanical characteristics of myocardial infarction border zones and ventricular arrhythmic risk: novel insights from grid-tagged cardiac magnetic resonance imaging. Eur Radiol, 22(8):1651-1658. Methodology: prospective observational, performed at one institution.

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Correspondence to Dennis T. L. Wong.

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Wong, D.T.L., Leong, D.P., Weightman, M.J. et al. Magnetic resonance-derived circumferential strain provides a superior and incremental assessment of improvement in contractile function in patients early after ST-segment elevation myocardial infarction. Eur Radiol 24, 1219–1228 (2014). https://doi.org/10.1007/s00330-014-3137-6

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Keywords

  • Circumferential strain
  • Myocardial viability
  • Late gadolinium enhancement
  • Myocardial grid tagging
  • Magnetic resonance imaging