Effects of hyperaemia on left ventricular longitudinal strain in patients with suspected coronary artery disease

Abstract

AimsMyocardial perfusion imaging during hyperaemic stress is commonly used to detect coronary artery disease. The aim of this study was to investigate the relationship between left ventricular global longitudinal strain (GLS), strain rate (GLSR), myocardial early (E’) and late diastolic velocities (A’) with adenosine stress first-pass perfusion cardiovascular magnetic resonance (CMR) imaging.Methods and results44 patients met the inclusion criteria and underwent CMR imaging. The CMR imaging protocol included: rest/stress horizontal long-axis (HLA) cine, rest/stress first-pass adenosine perfusion and late gadolinium enhancement imaging. Rest and stress HLA cine CMR images were analysed using feature-tracking software for the assessment of myocardial deformation. The presence of perfusion defects was scored on a binomial scale. In patients with hyperaemia-induced perfusion defects, rest global longitudinal strain GLS (−16.9 ± 3.7 vs. −19.6 ± 3.4; p-value = 0.02), E’ (−86 ± 22 vs. −109 ± 38; p-value = 0.02), GLSR (69 ± 31 vs. 93 ± 38; p-value = 0.01) and stress GLS (−16.5 ± 4 vs. −21 ± 3.1; p < 0.001) were significantly reduced when compared with patients with no perfusion defects. Stress GLS was the strongest independent predictor of perfusion defects (odds ratio 1.43 95% confidence interval 1.14–1.78, p-value <0.001). A threshold of −19.8% for stress GLS demonstrated 78% sensitivity and 73% specificity for the presence of hyperaemia-induced perfusion defects.ConclusionsAt peak myocardial hyperaemic stress, GLS is reduced in the presence of a perfusion defect in patients with suspected coronary artery disease. This reduction is most likely caused by reduced endocardial blood flow at maximal hyperaemia because of transmural redistribution of blood flow in the presence of significant coronary stenosis.Electronic supplementary materialThe online version of this article (10.1007/s12471-017-1071-3) contains supplementary material, which is available to authorized users.

Advances in Multimodality Cardiovascular Imaging in the Diagnosis of Heart Failure With Preserved Ejection Fraction

“…Moreover, myocardial tagging is routinely used for qualitative, inspective analysis, while time-consuming quantitative methods are usually reserved for research purposes. Such limitations have been overcome by feature tracking technique, which enables to measure systolic and diastolic myocardial strain and strain rate, by tracking anatomical features in LV myocardium along the cardiac cycle, in a fashion similar to echocardiography speckle tracking ( 91 ). Feature tracking analysis is performed on common bSSFP cine images and does not require additional sequences and scan time.…”

The Interfield Strength Agreement of Left Ventricular Strain Measurements at 1.5 T and 3 T Using Cardiac MRI Feature Tracking

“…With similarities to our findings, intraobserver and interobserver reproducibility for global longitudinal shortening using a semi-automated method has previously been shown to be better compared to GLS by feature tracking in a cohort consisting of normal controls and patients with heart failure. 19 As stress (exercise or pharmacological) increases LV GLS in healthy controls, 36,37 we randomized participants to field strength to minimize any systematic impact of anxiety on hemodynamic measurements. Noninvasive heart rate and blood pressure parameters were systematically measured during scan acquisition and were not different between participants at 1.5 T and 3 T.…”

Cardiac Magnetic Resonance Tissue Characterization in Ischemic Cardiomyopathy

“…100 Indeed, analysis of myocardial strain using CMR during stress can be useful to depict ischemic myocardium as demonstrated by Garg et al 101 In a small cohort of patients who underwent adenosine stress CMR the authors found an AUC of 0.82 for the depiction of global longitudinal strain abnormalities using as a gold standard perfusion defects. 101 It is important to note that strain could show different results based on the software used. 102 Although the use of dobutamine can depict ischemic myocardium with a sensitivity of 0.83 and specificity of 0.86, respectively, it is important to consider that the diagnostic performance may be influenced by the geometry of the ventricle.…”

“…The analysis of cine images could be implemented performing strain analysis 100. Indeed, analysis of myocardial strain using CMR during stress can be useful to depict ischemic myocardium as demonstrated by Garg et al101 In a small cohort of patients who underwent adenosine stress CMR the authors found an AUC of 0.82 for the depiction of global longitudinal strain abnormalities using as a gold standard perfusion defects 101. It is important to note that strain could show different results based on the software used 102…”