Correlation of Myocardial Strain and Late Gadolinium Enhancement by Cardiac Magnetic Resonance After a First Anterior ST-Segment Elevation Myocardial Infarction

Abstract

Objectives: To investigate the correlation of cardiac magnetic resonance (CMR) feature-tracking with conventional CMR parameters in patients with a first anterior ST-segment elevation myocardial infarction (STEMI).Methods: This sub-analysis of OCTAMI (Optical Coherence Tomography Examination in Acute Myocardial Infarction) registry included 129 patients who finished a CMR examination 1 month after a first anterior STEMI. Cine images were applied to calculate both global and segmental left ventricular peak strain parameters. The patients were divided into two groups by left ventricular ejection fraction (LVEF) and compared with 42 healthy controls. Segmental late gadolinium enhancement (LGE) was graded according to LGE transmurality as follows: (1) >0 to ≤ 25%; (2) >25 to ≤ 50%; (3) >50 to ≤ 75%; (4) >75%. Left ventricle was divided into infarcted, adjacent, and remote regions to assess regional function.Results: Compared with controls, global radial (28.39 ± 5.08% vs. 38.54 ± 9.27%, p < 0.05), circumferential (−16.91 ± 2.11% vs. −20.77 ± 2.78%, p < 0.05), and longitudinal (−13.06 ± 2.15 vs. −15.52 ± 2.69, p < 0.05) strains were impaired in STEMI patients with normal LVEF (≥55%). Strain parameters were strongly associated with LGE (radial: r = 0.65; circumferential: r = 0.69; longitudinal: r = 0.61; all p < 0.05). A significant and stepwise impairment of global strains was observed in groups divided by LGE tertiles. Furthermore, segmental strain was different in various degrees of LGE transmurality especially for radial and circumferential strain. Strains of adjacent region were better than infarcted region in radial and circumferential directions and worse than remote region in all three directions.Conclusion: Global and regional strain could stratify different extent and transmurality of LGE, respectively. Although without LGE, adjacent region had impaired strains comparing with remote region.

Diagnostic performance of cardiac magnetic resonance segmental myocardial strain for detecting microvascular obstruction and late gadolinium enhancement in patients presenting after a ST-elevation myocardial infarction

“…Consequently, in our analysis LGE might represent not only scar, but also edema, as scans were obtained within a short period of time after the event. Similarly, Yu et al ( 15 ) found in a patient cohort scanned within 1 month after the infarction a SCS cut-off of –10.2%, assessed by CMR-FT that yielded LGE detection with a sensitivity of 80% and specificity of 85%. When comparing different techniques (i.e., CMR-FT and TT) in patients after STEMI, TT showed a higher interobserver variability and correlated less strongly with infarct and showed overall higher values for circumferential strain ( 21 , 22 ), a possible factor contributing to different cut-off values and differences in the diagnostic performances.…”

“…Previous studies have reported a correlation of strain with the presence of LGE in STEMI patients (15,16) and MVO in addition to LGE seems to have a greater effect on strain (i.e., global) compared to LGE alone (17,18). Furthermore, it has been demonstrated that segmental strain bears the potential to detect MVO with high accuracy, however, specific cut-off values vary between groups due to different patient cohorts and the use of different modalities (i.e., echocardiographic strain or tagging sequences).…”

“…This is in line with the findings of a recent study by Sjögren et al were the comparison of strain in different culprit lesions, infarctions in the territory of the LAD affected remote strain ( 29 ). The most likely explanation for this phenomenon is related to tethering of strain from remote segments next to infarct, that are more affected compared to non-neighboring segments ( 15 , 30 , 31 ). The same seems to hold true for LGE segments adjacent to MVO segments as in our population, where “borderline” zones might have altered the calculated cut-off values.…”

Detection of myocardial fibrosis: Where we stand

“…CMR-FT is a more feasible approach based on the fast postprocessing of cine images, acquiring strain information (e.g., strain, strain rate, rotational mechanics) globally or segmentally in three orthogonal directions: longitudinal, circumferential and radial ( 50 ). Multiple strain parameters have been demonstrated their association with CMR tagging ( 128 ), LGE ( 129 ) and histological examination ( 130 ).…”

Cardiac Magnetic Resonance Feature Tracking Global and Segmental Strain in Acute and Chronic ST-elevation Myocardial Infarction

“…Not surprisingly, the relationship between segmental strain at followup and baseline-LGE declined by trend at six months. This development is also in uenced by the reduction of LGE extent over time, with LGE overestimating scar in the acute phase of MI 18,19,25 . Hence, strain at follow-up could re ect the improvement of myocardial function in former LGE + segments.…”