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

Abstract

BackgroundMicrovascular obstruction (MVO) and Late Gadolinium Enhancement (LGE) assessed in cardiac magnetic resonance (CMR) are associated with adverse outcome in patients with ST-elevation myocardial infarction (STEMI). Our aim was to analyze the diagnostic performance of segmental strain for the detection of MVO and LGE.MethodsPatients with anterior STEMI, who underwent additional CMR were enrolled in this sub-study of the CARE-AMI trial. Using CMR feature tracking (FT) segmental circumferential peak strain (SCS) was measured and the diagnostic performance of SCS to discriminate MVO and LGE was assessed in a derivation and validation cohort.ResultsForty-eight STEMI patients (62 ± 12 years old), 39 (81%) males, who underwent CMR (i.e., mean 3.0 ± 1.5 days) after primary percutaneous coronary intervention (PCI) were included. All patients presented with LGE and in 40 (83%) patients, MVO was additionally present. Segments in all patients were visually classified and 146 (19%) segments showed MVO (i.e., LGE+/MVO+), 308 (40%) segments showed LGE and no MVO (i.e., LGE+/MVO–), and 314 (41%) segments showed no LGE (i.e., LGE–). Diagnostic performance of SCS for detecting MVO segments (i.e., LGE+/MVO+ vs. LGE+/MVO–, and LGE–) showed an AUC = 0.764 and SCS cut-off value was –11.2%, resulting in a sensitivity of 78% and a specificity of 67% with a positive predictive value (PPV) of 30% and a negative predictive value (NPV) of 94% when tested in the validation group. For LGE segments (i.e., LGE+/MVO+ and LGE+/MVO– vs. LGE–) AUC = 0.848 and SCS with a cut-off value of –13.8% yielded to a sensitivity of 76%, specificity of 74%, PPV of 81%, and NPV of 70%.ConclusionSegmental strain in STEMI patients was associated with good diagnostic performance for detection of MVO+ segments and very good diagnostic performance of LGE+ segments. Segmental strain may be useful as a potential contrast-free surrogate marker to improve early risk stratification in patients after primary PCI.

Cardiac magnetic resonance feature tracking global and segmental strain in acute and chronic ST-elevation myocardial infarction

“…also studied patients in the acute phase after MI with an AUC of 0.91 for LV SCS and 0.74 for LV SLS for predicting infarct transmurality 75% 27 . Gräni et al studied patients approximately 3 days after STEMI with similarly high sensitivity for LV SCS to predict LGE (AUC = 0.84) as found in this cohort 17 . Yu et al .…”

“…Myocardial strain-imaging with FT, however, allows the calculation of regional deformation without the need for acquiring multiple additional sequences. Moreover, it has been proposed that FT CMR could have an incremental prognostic value to predict mortality after MI over LVEF and infarct size 16 and there is evidence that strain might be able to predict presence of MVO 17 . While global myocardial strain analysis is already implemented in various guidelines, segmental strain analysis is used restrictively due to lower reliability 18 .…”

Non-contrast cine cardiovascular magnetic resonance-based radiomics nomogram for predicting microvascular obstruction after reperfusion in ST-segment elevation myocardial infarction

“…Zhang et al (26) developed a deep learning framework based on non-contrast cine CMR that could detect the presence, location, transmurality, and size of chronic myocardial infarction without relying on additional LGE images, demonstrating the diagnostic capabilities of routinely acquired non-contrast cine CMR images for chronic myocardial infarction diagnosis. Gräni et al (27) included 48 STEMI patients who underwent CMR after PCI. Their study showed that segmental strain in patients with STEMI had a good diagnostic performance in identifying MVO+ and excellent diagnostic performance for LGE+ segments.…”

Prognostic value of visual and quantitative CMR regional myocardial function in patients with suspected myocarditis

“…CMR imaging was either performed on a 1.5 or 3.0 Tesla scanner (Magnetom Trio and Area, Siemens Healthineers, Erlangen, Germany) as described previously [ 4 , 7 , 9 ]. The application cvi41 (Circle Cardiovascular Imaging, Calgary, Canada) was used for postprocessing.…”

“…If required, values were either corrected for the peak strain at correct time to peak or excluded. Since reliability of segment based RLS is limited [ 9 ], segments were also summarized to different regions by calculating the mean RLS of summarized segments. Regions were defined as anterior (AHA-segments 1, 7, and 13), septal (segments 2, 3, 8, 9, 14), inferior (segments 4, 10, 15) and lateral (segments 5, 6, 11, 12, 16).…”