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Strain analysis using feature tracking cardiac magnetic resonance (FT-CMR) in the assessment of myocardial viability in chronic ischemic patients

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Abstract

The purpose of this study is to test the capability of a commercially available feature tracking-cardiac magnetic resonance (FT-CMR) strain analysis software module in differentiating between viable and non-viable myocardium in chronic ischemic patients. Thirty chronic ischemic patients and 10 healthy volunteers were enrolled. Cine images were used for peak circumferential and radial strains quantification using dedicated FT-CMR software. Global strain was compared between patients and controls. In patients, segmental strain was compared in viable and non-viable myocardium determined by late gadolinium enhancement (LGE); and in segments with wall abnormalities. Among 480 myocardial segments analyzed in patients, 76 segments were non-viable on LGE. The mean left ventricular ejection fraction (LVEF) of the patients (87% males, mean age 55 ± 12 years) was 40 ± 12% vs. 61 ± 5% for the controls (80% males, mean age 39 ± 11 years). Peak global circumferential strain (GCS) and global radial strain (GRS) were significantly impaired in patients compared to controls (−13.89 ± 4.12% vs. −19.84 ± 1.47%), p < 0.001 and (23.11 ± 6.59% vs. 31.72 ± 5.52%), p = 0.001. Segmental circumferential strain (SCS) and segmental radial strain (SRS) were significantly impaired in non-viable compared to viable segments (-9.47 ± 7.26% vs. -14.72 ± 7.5%), p < 0.001 and (15.67 ± 12.11% vs. 24.51 ± 16.22%), p < 0.001. Cut-off points of -9.36% for the SCS (AUC = 0.7, 95% CI = 0.63–0.77) and 19.5% for the SRS (AUC = 0.67, 95%CI = 0.61–0.73) were attained above which the segment is considered viable.

SCS was able to discriminate between normokinetic, hypokinetic and akinetic segments (mean = 27.6 ± 17.13%, 18.66 ± 12.88% and 15.24 ± 10.70% respectively, p < 0.001). Circumferential and radial segmental strain analysis by FT-CMR was able to discriminate between viable and non-viable segments of the myocardium defined by LGE and between normokinetic, hypokinetic and akinetic segments, using routinely acquired cine images, and thus can provide a more objective metric for risk stratification in chronic ischemic patients.

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Data availability

Datasets are available upon request.

Abbreviations

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

CCS:

Chronic coronary syndrome

FT-CMR:

Feature tracking-cardiac magnetic resonance

GCS:

Global circumferential strain

GRS:

Global radial strain

IHD:

Ischemic heart disease

LGE:

Late gadolinium enhancement

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

PCI:

Percutaneous coronary intervention

RWMA:

Regional wall motion abnormality

SCS:

Segmental circumferential strain

SRS:

Segmental radial strain

SSFP:

Steady-state free precession

STE:

Speckle tracking echocardiography

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Acknowledgements

The authors would like to thank Dr. Soha Romeih, Dr. Mahmoud Shaaban, Dr. Dina Osama, Dr. Ahmed Kharabish, Dr. Dina Haroun and Dr. Fatma El Kafrawy for their contribution.

Funding

This study was not supported by internal or external funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Ain Shams University Hospitals, Cairo, Egypt

    Sara W. Tantawy, Shaimaa Abdelsattar Mohammad, Ahmed M. Osman & Ahmed S. Ibrahim

  2. Department of Radiology/Cardiovascular Imaging, Aswan Heart Center-Magdi Yacoub Foundation, Aswan, Egypt

    Sara W. Tantawy & Wesam El Mozy

  3. Department of Radiology, Cairo University Hospitals, Cairo, Egypt

    Wesam El Mozy

Authors
  1. Sara W. Tantawy
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  2. Shaimaa Abdelsattar Mohammad
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  3. Ahmed M. Osman
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  4. Wesam El Mozy
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  5. Ahmed S. Ibrahim
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by ST and WEM. The first draft of the manuscript was written by ST and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sara W. Tantawy.

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Nothing to disclose.

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Was obtained from all participants.

Ethical approval

The study was conducted according to the stipulations of the Ain Shams University (ASU) Ethical and Scientific Committee, keeping the privacy of participants and confidentiality of data, in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Written informed consent was read and signed by the patient himself or his/her relative.

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Tantawy, S.W., Mohammad, S.A., Osman, A.M. et al. Strain analysis using feature tracking cardiac magnetic resonance (FT-CMR) in the assessment of myocardial viability in chronic ischemic patients. Int J Cardiovasc Imaging 37, 587–596 (2021). https://doi.org/10.1007/s10554-020-02018-w

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  • DOI: https://doi.org/10.1007/s10554-020-02018-w

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