Prognostic value of myocardial deformation imaging by cardiac magnetic resonance feature-tracking in patients with a first ST-segment elevation myocardial infarction

Nucifora, Gaetano; Muser, Daniele; Tioni, Chiara; Shah, Ranjit; Selvanayagam, Joseph B.

doi:10.1016/j.ijcard.2018.05.082

Cited by 26 publications

(17 citation statements)

References 23 publications

(30 reference statements)

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“…Cine imaging, which is an essential part of each CMR protocol, provides a detailed analysis of right and left chamber volumes and cardiac function (mainly ejection fraction) with crucial prognostic implications [4]. Importantly, cine CMR holds much more detailed information that enables assessment of more comprehensive markers of cardiac function, such as myocardial strain that may be even more informative for prognostication after STEMI than standard chamber volumes and ejection fraction [5][6][7]. A large body of evidence has demonstrated the great value of infarct severity assessment with CMR for the prediction of future cardiovascular events [3].…”

Section: Introductionmentioning

confidence: 99%

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

Reindl

Eitel

Reinstadler

2020

JCM

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Cardiac magnetic resonance (CMR) imaging allows comprehensive assessment of myocardial function and tissue characterization in a single examination after acute ST-elevation myocardial infarction. Markers of myocardial infarct severity determined by CMR imaging, especially infarct size and microvascular obstruction, strongly predict recurrent cardiovascular events and mortality. The prognostic information provided by a comprehensive CMR analysis is incremental to conventional risk factors including left ventricular ejection fraction. As such, CMR parameters of myocardial tissue damage are increasingly recognized for optimized risk stratification to further ameliorate the burden of recurrent cardiovascular events in this population. In this review, we provide an overview of the current impact of CMR imaging on optimized risk assessment soon after acute ST-elevation myocardial infarction.

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Section: Introductionmentioning

confidence: 99%

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

Reindl

Eitel

Reinstadler

2020

JCM

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“…Additionally, CMR is the gold-standard technique for LV volumetric assessment and infarct size (IS) quantification [8,9]. Ecc detected by CMR can predict functional recovery, worse long-term outcomes and provide additional prognostic information beyond conventional clinical and CMR variables (not shown for GLS [10]) in patients with a first STEMI [11,12]. Furthermore, Ecc maybe the most reproducible strain parameter with the least intertechnique variation [13][14][15][16][17].…”

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confidence: 99%

“…However, an advantage with TT is that volumetric, functional and strain analysis can be performed on a single software platform, without re-contouring per sequence. Strain assessed by FT and TT has been shown to predict major adverse cardiovascular events following STEMI [11,22].…”

mentioning

confidence: 99%

Inter-study repeatability of circumferential strain and diastolic strain rate by CMR tagging, feature tracking and tissue tracking in ST-segment elevation myocardial infarction

Nazir

Shetye

Khan

et al. 2020

Int J Cardiovasc Imaging

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Strain assessment allows accurate evaluation of myocardial function and mechanics in ST-segment elevation myocardial infarction (STEMI). Strain using cardiovascular magnetic resonance (CMR) has traditionally been assessed with tagging but limitations of this technique have led to more widespread use of alternative methods, which may be more robust. We compared the inter-study repeatability of circumferential global peak-systolic strain (Ecc) and peak-early diastolic strain rate (PEDSR) derived by tagging with values obtained using novel cine-based software: Feature Tracking (FT) (TomTec, Germany) and Tissue Tracking (TT) (Circle cvi 42 , Canada) in patients following STEMI. Twenty male patients (mean age 56 ± 10 years, mean infarct size 13.7 ± 7.1% of left ventricular mass) were randomised to undergo CMR 1-5 days post-STEMI at 1.5 T or 3.0 T, repeated after ten minutes at the same field strength. Ecc and PEDSR were assessed using tagging, FT and TT. Inter-study repeatability was evaluated using Bland-Altman analyses, coefficients of variation (CoV) and intraclass correlation coefficient (ICC). Ecc (%) was significantly lower with tagging than with FT or TT at 1.5 T (− 9.5 ± 3.3 vs. − 17.5 ± 3.8 vs. −15.5 ± 5.2, respectively, p < 0.001) and 3.0 T (− 13.1 ± 1.8 vs. − 19.4 ± 2.9 vs. − 17.3 ± 2.1, respectively, p = 0.001). This was similar for PEDSR (.s −1 ): 1.5 T (0.6 ± 0.2 vs. 1.5 ± 0.4 vs. 1.0 ± 0.4, for tagging, FT and TT respectively, p < 0.001) and 3.0 T (0.6 ± 0.2 vs. 1.5 ± 0.3 vs. 0.9 ± 0.3, respectively, p < 0.001). Inter-study repeatability for Ecc at 1.5 T was good for tagging and excellent for FT and TT: CoV 16.7%, 6.38%, and 8.65%, respectively. Repeatability for Ecc at 3.0 T was good for all three techniques: CoV 14.4%, 11.2%, and 13.0%, respectively. However, repeatability of PEDSR was generally lower than that for Ecc at 1.5 T (CoV 15.1%, 13.1%, and 34.0% for tagging, FT and TT, respectively) and 3.0 T (CoV 23.0%, 18.6%, and 26.2%, respectively). Following STEMI, Ecc and PEDSR are higher when measured with FT and TT than with tagging. Inter-study repeatability of Ecc is good for tagging, excellent for FT and TT at 1.5 T, and good for all three methods at 3.0 T. The repeatability of PEDSR is good to moderate at 1.5 T and moderate at 3.0 T. Cine-based methods to assess Ecc following STEMI may be preferable to tagging.

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“…Scar tissue leads to altered strain behavior of the myocardium due to reduced contractility of myo broblasts, which replace myocytes after infarction. Recent studies focused on the investigation of global strain parameters in patients with acute and chronic infarcts, revealing reduced global longitudinal and global circumferential strain in these patients [23,24]. Until now, only few studies examined segmental strain in patients with infarction [25,26], possibly because reduced accuracy and reproducibility of segmental strain values was reported for optical ow-based FT methods in the past [27].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Segmental Strain for the Detection of Chronic Ischemic Scars in Non-Contrast Cardiac MRI Cine Images: A Feasibility Study

Polacin¹,

Károlyi²,

Eberhard³

et al. 2020

Preprint

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Aims Cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) is considered the gold standard for scar detection after myocardial infarction. In times of increasing skepticism about gadolinium depositions in brain tissue and contraindications of gadolinium administration in some patient groups, tissue strain-based techniques for detecting ischemic scars should be further developed as part of clinical protocols. Therefore, the objective of the present work was to investigate the feasibility of scar detection in segmental strain calculations based on routinely acquired non-contrast cine images in patients with chronic infarcts.Methods Forty-six patients with chronic infarcts and scar tissue in LGE images (5 female, mean age 52 ± 19 years) and 24 gender- and age- matched healthy controls (2 female, mean age 47 ± 13 years) were included. Global (global peak circumferential [GPCS], global peak longitudinal [GPLS], global peak radial strain [GPRS]) and segmental (segmental peak circumferential [SPCS], segmental peak longitudinal [SPLS], segmental peak radial strain [SPRS]) strain parameters were calculated from standard balanced SSFP cine sequences using commercially available software (Segment CMR, Medviso, Sweden). Two independent blinded readers localized potentially infarcted segments in segmental circumferential strain calculations (endo-/epicardially contoured short axis cine and resulting polar plot strain map) and by visual wall motion assessment of cine images. Results Global strain values were reduced in patients compared to controls (GPCS p= 0.02; GPLS p= 0.04; GPRS p= 0.01). Patients with preserved ejection fraction showed also reduced GPCS compared to healthy individuals (p=0.04). In patients, mean SPCS was significantly impaired in subendocardially (- 5,4% +/- 2) and in transmurally infarcted segments (- 1,2% ± 3) compared to remote myocardium (-12,9% +/- 3, p= 0.02 and 0.03, respectively). ROC analysis revealed an optimal cut- off value for SPCS for discriminating infarcted from remote myocardium of - 7,2 % with a sensitivity of 89,4 % and specificity of 85,7%. Mean SPRS was impeded in transmurally infarcted segments (15,9 % +/- 6) compared to SPRS of remote myocardium (31,4% +/- 5; p= 0.02). The optimal cut-off value for SPRS for discriminating scar tissue from remote myocardium was 16,6% with a sensitivity of 83,3% and specificity of 76,5%. 80.3 % of all in LGE infarcted segments (118/147) were correctly localized in segmental circumferential strain calculations based on non-contrast cine images compared to 53.7% (79/147) of infarcted segments detected by visual wall motion assessment (p > 0.01). Conclusion Global strain parameters are impaired in patients with chronic infarcts compared to healthy individuals. Mean SPCS and SPRS in scar tissue is impeded compared to remote myocardium in infarcts patients. Blinded to LGE images, two readers correctly localized 80% of infarcted segments in segmental circumferential strain calculations based on non-contrast cine images, in contrast to only 54% of infarcted segments detected by visual wall motion assessment. Analysis of segmental circumferential strain shows a promising alternative for scar detection based on routinely acquired, non-contrast cine images for patients who cannot receive or decline gadolinium.

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Prognostic value of myocardial deformation imaging by cardiac magnetic resonance feature-tracking in patients with a first ST-segment elevation myocardial infarction

Abstract: LV GCS assessed by CMR feature-tracking can predict a worse long-term prognosis in patients admitted with a first STEMI. More importantly, the predictive ability of LV GCS is incremental to other clinical and CMR variables.

Cited by 26 publications

References 23 publications

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

Inter-study repeatability of circumferential strain and diastolic strain rate by CMR tagging, feature tracking and tissue tracking in ST-segment elevation myocardial infarction

Analysis of Segmental Strain for the Detection of Chronic Ischemic Scars in Non-Contrast Cardiac MRI Cine Images: A Feasibility Study

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